Locate Peptic Ulcer Codes Precisely
Question: Our pathologist examined a duodenum biopsy from an esophagogastroduodenoscopy (EGD) and they performed an H. pylori test on the specimen, which was positive. The final diagnosis is peptic ulcer. How should we code this? Maine Subscriber Answer: Report the pathologist’s biopsy exam using 88305 (Level IV - Surgical pathology, gross and microscopic examination … Stomach, biopsy …). For the Helicobacter pylori (or H. pylori) test on the biopsy specimen, labs typically perform a “campylobacter like organism” (CLO) test, which you can report using 87081 (Culture, presumptive, pathogenic organisms, screening only). For the diagnosis code, it is important to note that peptic ulcers are coded to the location of the ulcer. As you know it is located in the duodenum, that means skipping over the K27.- (Peptic ulcer, site unspecified) codes. You’ll also pass over K22.1 (Ulcer of esophagus), as even though peptic ulcer is listed as one of the code’s inclusion terms, the location of the ulcer is not the esophagus. Instead, you’ll turn to the K26.- (Duodenal ulcer) codes, which lists duodenum ulcer (peptic) and postpyloric ulcer (peptic) as inclusion terms. From there, you will need more information to narrow down the code choice. Specifically, you will need to know if the ulcer is acute or chronic, and whether the ulcer is hemorrhagic, perforated, both, or neither. Peptic ulcers of the duodenum that are unspecified as to whether they are acute or chronic are confusingly categorized to one of the chronic codes, while chronic/unspecified duodenal ulcers without hemorrhage or perforation are divided into two codes: K26.7 (Chronic duodenal ulcer without hemorrhage or perforation) or K26.9 (Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation). And don’t forget to follow the Use additional code instruction for K26.-, which tells you to add an alcohol abuse and dependence code from F10.- (Alcohol related disorders) Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
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