Version 2024

2024 ICD-10-CM Diagnosis Code K25.1

Acute gastric ulcer with perforation

ICD-10-CM Code:: K25.1
Short Description:: Acute gastric ulcer with perforation
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Not chronic
Code Navigator:

1. Approximate Synonyms
2. Clinical Classification
3. Tabular List of Diseases and Injuries
4. Index to Diseases and Injuries References
5. Diagnostic Related Groups - MS-DRG Mapping
6. Convert to ICD-9 Code
7. Patient Education
8. Other Codes Used Similar Conditions
9. Code History

Code Classification

Diseases of the digestive system
(K00–K95)
- Diseases of esophagus, stomach and duodenum
  (K20-K31)
  - Gastric ulcer
    (K25)

K25.1 is a billable diagnosis code used to specify a medical diagnosis of acute gastric ulcer with perforation. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Acute gastric ulcer with obstruction
Acute gastric ulcer with perforation
Acute gastric ulcer with perforation AND obstruction
Acute gastric ulcer with perforation but without obstruction
Acute peptic ulcer with perforation AND obstruction
Gastric ulcer with perforation but without obstruction

Clinical Classification

Clinical Category	CCSR Category Code	Inpatient Default CCSR	Outpatient Default CCSR
Gastroduodenal ulcer	DIG005	Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.	Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.
Gastrointestinal and biliary perforation	DIG006	N - Not default inpatient assignment for principal diagnosis or first-listed diagnosis.	N - Not default outpatient assignment for principal diagnosis or first-listed diagnosis.

Index to Diseases and Injuries References

The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).

- Ulcer, ulcerated, ulcerating, ulceration, ulcerative
- - stomach (eroded) (peptic) (round) - K25.9
  - - acute - K25.3
    - - with
      - - perforation - K25.1

K25.1 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
380	COMPLICATED PEPTIC ULCER WITH MCC	06	1.9485
381	COMPLICATED PEPTIC ULCER WITH CC	06	1.073
382	COMPLICATED PEPTIC ULCER WITHOUT CC/MCC	06	0.7571

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert K25.1 to ICD-9-CM

ICD-9-CM Code: 531.10 - Ac stomach ulcer w perf
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Patient Education

Peptic Ulcer

A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your small intestine. A burning stomach pain is the most common symptom. The pain:

Starts between meals or during the night
Briefly stops if you eat or take antacids
Lasts for minutes to hours
Comes and goes for several days or weeks

Peptic ulcers happen when the acids that help you digest food damage the walls of the stomach or duodenum. The most common cause is infection with a bacterium called Helicobacter pylori. Another cause is the long-term use of nonsteroidal anti-inflammatory medicines (NSAIDs) such as aspirin and ibuprofen. Stress and spicy foods do not cause ulcers, but can make them worse.

To see if you have an H. pylori infection, your doctor will test your blood, breath, or stool. Your doctor also may look inside your stomach and duodenum by doing an endoscopy or x-ray.

Peptic ulcers will get worse if not treated. Treatment may include medicines to reduce stomach acids or antibiotics to kill H. pylori. Antacids and milk can't heal peptic ulcers. Not smoking and avoiding alcohol can help. You may need surgery if your ulcers don't heal.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

[Learn More in MedlinePlus]

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.