2027 ICD-10-CM Diagnosis Code K25.5Chronic or unspecified gastric ulcer with perforation
ICD-10-CM Codes›K00–K95›K20-K31›K25
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 78
- Chronic Condition
K25.5 is a billable ICD-10-CM diagnosis code for chronic or unspecified gastric ulcer with perforation. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 380 through 382. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 75 closely related codes. Coders also document this condition as chronic gastric ulcer with obstruction. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Gastroduodenal ulcer and Gastrointestinal and biliary perforation.
For Medicare Advantage risk adjustment, K25.5 maps to CMS-HCC Category 78 (Intestinal Obstruction/Perforation) under the V28 model, adding a risk factor of about 0.326 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
K25.5 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Chronic gastric ulcer with obstruction
- Chronic gastric ulcer with perforation
- Chronic gastric ulcer with perforation AND with obstruction
- Chronic gastric ulcer with perforation but without obstruction
- Chronic peptic ulcer with perforation AND obstruction
- Chronic peptic ulcer with perforation but without obstruction
- Gastric ulcer with perforation
- Gastric ulcer with perforation AND obstruction
- Gastric ulcer with perforation but without obstruction
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to K25.5: its own notes plus those printed at K25, block K20-K31, and Chapter 11. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- erosion (acute) of stomach
- pylorus ulcer (peptic)
- stomach ulcer (peptic)
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- hiatus hernia (K44.-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name K25.5, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming K25.5: they are not reported together with it, unless the two conditions are unrelated.
Code First 1
These codes say to code first a condition named in the note, and K25.5 is one of the conditions named.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Stomach Ulcer
ulceration of the gastric mucosa due to contact with gastric juice. it is often associated with helicobacter pylori infection or consumption of nonsteroidal anti-inflammatory drugs (nsaids).
Patient EducationClinical
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:
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert K25.5 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About K25.5Overview
What is the ICD-10 code for chronic or unspecified gastric ulcer with perforation?
The ICD-10-CM code for chronic or unspecified gastric ulcer with perforation is K25.5 (sometimes written as K255). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is K25.5 (Gastric ulcer) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report chronic or unspecified gastric ulcer with perforation on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does K25.5 group to?
When chronic or unspecified gastric ulcer with perforation is the principal diagnosis on an inpatient stay, it groups to MS-DRG 381, 380, 382, with relative weights from 0.7283 to 1.9243 depending on complications. Higher weights mean higher Medicare reimbursement.
Is K25.5 a CC or MCC?
CMS lists K25.5 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 75 closely related codes in its exclusion list.
Can K25.5 be reported with a code from K29.0?
Not as a rule. The Excludes1 note at K25, which applies to K25.5, lists "acute gastritis (K29.0-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is K25.5?
K25.5 (chronic or unspecified gastric ulcer with perforation) maps to CMS-HCC Category 78 (Intestinal Obstruction/Perforation), commonly written as HCC 78, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 33 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does K25.5 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, K25.5 adds a risk adjustment factor of about 0.326 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.326 to 0.688 depending on the payment segment). A more severe related category (HCC 77) supersedes it when both are reported. See the full factor table on the HCC 78 category page.
