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K26.5
ICD-10-CM
Perforated Duodenal Ulcer

Find information on perforated duodenal ulcer diagnosis, including clinical documentation requirements, ICD-10 codes (K26.1, K26.2), SNOMED CT concepts, and medical coding guidelines. Learn about symptoms, treatment options, and complications associated with perforated duodenal ulcers for accurate healthcare coding and documentation. This resource provides essential information for physicians, clinicians, and medical coders dealing with gastrointestinal perforations.

Also known as

Duodenal Ulcer with Perforation
Perforated Peptic Ulcer

Related ICD-10 Code Ranges

Complete code families applicable to AAPC K26.5 Coding
K25-K28

Peptic ulcer

Covers various peptic ulcers, including duodenal.

K26

Duodenal ulcer

Specifically addresses ulcers of the duodenum.

K25.1

Gastric ulcer acute with perforation

While gastric, includes perforation as a key feature.

T85.2

Complication of stomach surgery

Relevant if perforation is due to prior surgery.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the duodenal ulcer perforated?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Perforated duodenal ulcer
Gastric ulcer with perforation
Acute pancreatitis

Documentation Best Practices

Documentation Checklist
  • Document ulcer location in duodenum.
  • Describe perforation characteristics (size, location).
  • Note signs/symptoms: abdominal pain, rigidity.
  • Imaging confirmation (e.g., free air on X-ray).
  • Surgical intervention details if performed.

Coding and Audit Risks

Common Risks
  • Unconfirmed Perforation

    Coding for perforation without explicit documentation confirming free air/leakage leads to overcoding and potential denials.

  • Unspecified Location

    Lack of duodenal location specificity can impact DRG assignment and reimbursement. CDI should clarify location within the duodenum.

  • Comorbidity Coding

    Missing documentation of associated conditions like bleeding or obstruction can lead to undercoding and lost revenue.

Mitigation Tips

Best Practices
  • Accurate ICD-10-CM K26.x coding for duodenal ulcer site
  • Thorough HPI documentation: ulcer history, symptoms, onset
  • Timely surgical intervention documentation for compliance
  • Concurrent CDI review for perforation, peritonitis capture
  • POA indicator validation for accurate reimbursement

Clinical Decision Support

Checklist
  • Sudden severe epigastric pain (ICD-10: K25.1)?
  • Signs of peritonitis documented (Ruptured viscus: T81.2)?
  • Free air under diaphragm on imaging (SNOMED CT: 125605004)?
  • Hx of peptic ulcer disease (K26.-) or NSAID use?
  • Surgical consult ordered (Patient Safety: Critical)

Reimbursement and Quality Metrics

Impact Summary
  • **Reimbursement and Quality Metrics Impact Summary: Perforated Duodenal Ulcer**
  • **Keywords:** ICD-10 K25.1, DRG 331, Complication, Comorbidity, Case Mix Index, Hospital Acquired Condition, Present on Admission, Sepsis, Mortality, Length of Stay, Medical Billing, Coding Accuracy, Hospital Reporting, Value-Based Purchasing, Reimbursement
  • **Impact 1:** Increased DRG weighting, impacting reimbursement. Higher resource utilization.
  • **Impact 2:** Potential HAC if perforation occurs post-admission, affecting quality scores and payment.
  • **Impact 3:** Increased LOS and potential for complications like sepsis impacting mortality rates and reporting.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code K26.2 for perforated ulcer
  • Document ulcer location clearly
  • Specify acute vs chronic
  • Query physician if unclear
  • Include supporting diagnoses

Documentation Templates

Patient presents with acute onset of severe epigastric pain, described as sharp, stabbing, and radiating to the back.  Symptoms began suddenly, approximately [number] hours prior to presentation.  The patient reports associated symptoms including nausea, vomiting, and diaphoresis.  Physical examination reveals abdominal rigidity, guarding, and rebound tenderness suggestive of peritonitis.  The patient's medical history is significant for [mention relevant history, e.g., peptic ulcer disease, H. pylori infection, NSAID use].  Vital signs demonstrate tachycardia and hypotension, indicating possible hypovolemic shock.  Differential diagnosis includes perforated duodenal ulcer, acute pancreatitis, cholecystitis, and myocardial infarction.  Initial laboratory studies reveal leukocytosis and elevated amylase levels.  An upright chest x-ray demonstrates free air under the diaphragm, consistent with a perforated viscus.  Abdominal CT scan with IV contrast confirms the diagnosis of perforated duodenal ulcer, revealing free intraperitoneal air and fluid.  Surgical consultation obtained.  The patient was started on intravenous fluids, broad-spectrum antibiotics (e.g., piperacillin-tazobactam), and nasogastric suction.  Given the clinical presentation, imaging findings, and hemodynamic instability, the patient is being prepared for emergency exploratory laparotomy for definitive surgical management of the perforated duodenal ulcer.  Surgical plan includes primary closure of the perforation and possible omental patch reinforcement. Postoperative care will include pain management, continued antibiotic therapy, and monitoring for complications such as sepsis, abscess formation, and delayed gastric emptying.  Diagnosis: Perforated duodenal ulcer.  Procedure: Exploratory laparotomy, primary closure of duodenal perforation.  ICD-10 code: K25.1.