Radiology Coding Alert

Heads up: You won’t always have a one-to-one match.

When your radiologist performs a GI study, he can often discover gastric ulcers — which means you’ve got to apply the appropriate diagnosis code. A common factor for the diagnosis coding for gastric ulcer in ICD-9 and ICD-10 is that your choice is guided by the presenting complications in both the acute and chronic gastric ulcers. However, there is not always a one-to-one match. Here is how you can avoid complicating your diagnosis reporting for gastric ulcers in 2014.

Check if Hemorrhage is Documented

The ICD-9 code 531.00 (Acute gastric ulcer with hemorrhage without obstruction) for acute gastric ulcer with hemorrhage maps to ICD-10 code K25.0 (Acute gastric ulcer with hemorrhage). There is a change in the descriptor in ICD-10. The descriptor of the ICD-10 code mentions only hemorrhage and does not specify that obstruction is absent.

Similarly, when your physician documents a chronic gastric ulcer with hemorrhage, you report ICD-9 code 531.40 (Chronic or unspecified gastric ulcer with hemorrhage without obstruction). This maps to ICD-10 code K25.4 (Chronic or unspecified gastric ulcer with hemorrhage). The same codes also apply when your physician does not document if the gastric ulcer is acute or chronic.

Be Specific for Obstruction with K56.60

When both hemorrhage and obstruction are present with an acute gastric ulcer, you report ICD-9 code 531.01 (Acute gastric ulcer with hemorrhage with obstruction). In ICD-10, there are two corresponding codes, i.e. K25.0 (Acute gastric ulcer with hemorrhage) and K56.60 (Unspecified intestinal obstruction).

For a chronic or unspecified gastric ulcer that has complications of hemorrhage and obstruction, you turn to code 531.41 (Chronic or unspecified gastric ulcer with hemorrhage with obstruction). In ICD-10, you report two corresponding codes, i.e. K25.4 (Chronic or unspecified gastric ulcer with hemorrhage) for hemorrhage and K56.60 for obstruction.

Pinpoint These Perforation Codes

When your physician documents an acute gastric ulcer with perforation, you report ICD-9 code 531.10 (Acute gastric ulcer with perforation without obstruction) and the corresponding ICD-10 code K25.1 (Acute gastric ulcer with perforation). When you read that both perforation and obstruction are present with the acute gastric ulcer, you report code 531.11 (Acute gastric ulcer with perforation with obstruction). In ICD-10, you will have two corresponding codes, K25.1 (Acute gastric ulcer with perforation) for perforation and K56.60 for obstruction.

The ICD-9 code for a chronic or unspecified gastric ulcer with perforation is 531.50 (Chronic or unspecified gastric ulcer with perforation without obstruction) and the ICD-10 code for the same is K25.5 (Chronic or unspecified gastric ulcer with perforation). For a chronic ulcer with both perforation and obstruction, you report ICD-9 code 531.51 (Chronic or unspecified gastric ulcer with perforation with obstruction). In ICD-10, you have 2 codes to look at, K25.5 (Chronic or unspecified gastric ulcer with perforation) for perforation and K56.60 for obstruction.

You May Come Across More Than One Complication

When complications of both hemorrhage and perforation are present, you report ICD-9 code 531.20 (Acute gastric ulcer with hemorrhage and perforation without obstruction). When hemorrhage, obstruction, and perforation are present together, you report ICD-9 code 531.21 (Acute gastric ulcer with hemorrhage and perforation with obstruction). The code 531.20 maps to ICD-10 code K25.2 (Acute gastric ulcer with both hemorrhage and perforation) and code 531.21 maps to codes K25.2 (Acute gastric ulcer with both hemorrhage and perforation) and K56.60.

In cases of chronic or unspecified gastric ulcer with hemorrhage and perforation, you look for ICD-9 code 531.60 (Chronic or unspecified gastric ulcer with hemorrhage and perforation without obstruction). The corresponding ICD-10 code is K25.6 (Chronic or unspecified gastric ulcer with both hemorrhage and perforation). In cases of an additional obstruction, you submit ICD-9 code 531.61 (Chronic or unspecified gastric ulcer with hemorrhage and perforation with obstruction), which maps to ICD-10 codes K25.6 (Chronic or unspecified gastric ulcer with both hemorrhage and perforation) and K56.60.

You Can Earn For No Complications

When there are no complications with an acute gastric ulcer, you report ICD-9 code 531.30 (Acute gastric ulcer without hemorrhage or perforation without obstruction) which has a one-to-one match with ICD-10 code K25.3 (Acute gastric ulcer without hemorrhage or perforation).

For chronic gastric ulcer, you look at ICD-9 code 531.70 (Chronic gastric ulcer without hemorrhage or perforation without obstruction) and ICD-10 code K25.7 (Chronic gastric ulcer without hemorrhage or perforation).

When your physician does not specify the acute or chronic nature of the gastric ulcer, you have ICD-9 code 531.90 (Gastric ulcer unspecified as acute or chronic without hemorrhage or perforation without obstruction) and ICD-10 code K25.9 (Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation).

Do Not Miss Obstruction Alone

If obstruction is the only complication in an acute gastric ulcer that your physician documents, you report ICD-9 code 531.31 (Acute gastric ulcer without hemorrhage or perforation with obstruction). In ICD-10, you will see that both codes 531.30 and 531.31 map to code K25.3. Additionally, you report ICD-10 code K56.60 for the obstruction.

Similarly, for chronic gastric ulcer with obstruction, you have ICD-9 code 531.71 (Chronic gastric ulcer without hemorrhage or perforation with obstruction) for obstruction. This code maps to ICD-10 codes K25.7 (Chronic gastric ulcer without hemorrhage or perforation) and K56.60.

When you have no documentation for acute or chronic nature of the gastric ulcer, you look at ICD-9 code 531.91 (Gastric ulcer unspecified as acute or chronic without hemorrhage or perforation with obstruction) which maps to codes K25.9 (Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation) and K56.60 in ICD-10.