ICD 10 Coding Alert

Observe minor changes to list of inclusions and exclusions.

When you report gastric ulcer diagnoses after Oct.1, 2014, you will no longer have to focus on obstructions -- ICD-10 codes will only need you to concentrate on chronicity, along with presence or absence of hemorrhage and perforations.

Don’t Forget 5th Digit Expansion While Using ICD-9

For gastric ulcer reporting in ICD-9, you will have to first start out with the base code 531 (Gastric ulcer). Then, depending on chronicity, presence or absence of perforation and hemorrhage, you use a 4th digit expansion to report gastric ulcer using the following 9 codes:

• 531.0 (Acute gastric ulcer with hemorrhage)
• 531.1 (Acute gastric ulcer with perforation)
• 531.2 (Acute gastric ulcer with hemorrhage and perforation)
• 531.3 (Acute gastric ulcer without mention of hemorrhage or perforation)
• 531.4 (Chronic or unspecified gastric ulcer with hemorrhage)
• 531.5 (Chronic or unspecified gastric ulcer with perforation)
• 531.6 (Chronic or unspecified gastric ulcer with hemorrhage and perforation)
• 531.7 (Chronic gastric ulcer without mention of hemorrhage or perforation)
• 531.9 (Gastric ulcer unspecified as acute or chronic without mention of hemorrhage or perforation)

Key: Each of the above mentioned codes will further expand into two codes using a 5th digit expansion, depending on the presence or absence of obstruction.

For example, 531.0 will expand into the following two codes:

• 531.00 (Acute gastric ulcer with hemorrhage without obstruction)
• 531.01 (Acute gastric ulcer with hemorrhage with obstruction)

Nix Obstructions in ICD-10

When ICD-10 codes come into use, 531 in the ICD-9 code system crosswalks to K25 (Gastric ulcer) in ICD-10. The list of inclusions will add on acute erosion of the stomach, while exclusion lists will also comprise acute gastritis (K29.0-).

Vital: The presence or absence of obstruction will not contribute towards arriving at the right code to report while chronicity and presence or absence of perforation and hemorrhage will still be essential.

K25 will further expand to the following nine codes, depending on the factors mentioned above:

• K25.0 (Acute gastric ulcer with hemorrhage)
• K25.1 (Acute gastric ulcer with perforation)
• K25.2 (Acute gastric ulcer with both hemorrhage and perforation)
• K25.3 (Acute gastric ulcer without hemorrhage or perforation)
• K25.4 (Chronic or unspecified gastric ulcer with hemorrhage)
• K25.5 (Chronic or unspecified gastric ulcer with perforation)
• K25.6 (Chronic or unspecified gastric ulcer with both hemorrhage and perforation)
• K25.7 (Chronic gastric ulcer without hemorrhage or perforation)
• K25.9 (Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation)

Capture These Details in the Documentation

Some symptoms that you are most likely to encounter in the patient documentation in a patient suffering from gastric ulcers include upper abdominal pain, vomiting, bloating, melena, weight loss, loss of appetite and hematemesis.

Based on the symptoms, if your gastroenterologist suspects gastric ulcers, he might order diagnostic radiological examination such as a barium upper gastrointestinal series. He might instead perform an upper gastroesophagoduodenoscopy (43235, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) and later perform a breath test for detection of H. pylori (83013, Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope [e.g., C-13] and 83014, Helicobacter pylori; drug administration).

Example: Your gastroenterologist sees a patient who arrives at his office with complaints of upper abdominal pain that has been present for a while now. He also complains of loss of appetite and weight loss over a period of time. He says that he has been on pain killers for a back problem that resulted from an accident that occurred about eight years back.

Your gastroenterologist assesses the patient and decides to perform an upper EGD to ascertain the cause of the upper abdominal pain that the patient is experiencing. During the EGD, your gastroenterologist notes the presence of ulcers in the stomach with signs of hemorrhage and signs of previously formed ulcers that have now healed. He also notes that there are no signs of perforation or obstruction. He obtains a biopsy of the antrum which later reveals the presence of H. pylori infection.

Based on the symptoms, results of tests, and observations made during the EGD, your gastroenterologist confirms a diagnosis of chronic gastric ulcer and prescribes therapy with a proton pump inhibitor medication and a course of antibiotics for the H. pylori infection. A few weeks later the patient returns for a breath test to verify eradication of the H. pylori infection.

How to code: You report the EGD with 43239 and the breath test with 83013. You report the diagnosis with 531.40 (Chronic or unspecified gastric ulcer with hemorrhage without obstruction) if you are using ICD-9 codes and K25.4 if you are using ICD-10 code sets. For the H. Pylori infection you report the diagnosis with 041.86 if you are using ICD-9 codes and B96.81 if you are using ICD-10 codes.