Crystal's Coder Hub🧬 ICD-10-CM K25.0 — Acute Gastric Ulcer with Hemorrhage
Billable Code Confirmed
ICD-10-CM K25.0 is a valid, billable 4-character diagnosis code for FY2026. Character breakdown:
K25= gastric ulcer category;.0= acute with hemorrhage specificity axis. No additional characters (Query Response) are required for this code.
Non-Billable Parent Codes — Never Submit These
❌
K25— 3-character header — lacks specification of acute/chronic and presence of hemorrhage/perforation ❌K25.0is complete; do not add extra digits (e.g., K25.00 does not exist)Always submit K25.0 (all 4 characters) when acute gastric ulcer with documented hemorrhage is confirmed.
Clinical Context: Acute vs. Chronic Distinction
ICD-10-CM K25.0 captures the critical distinction between acute gastric ulcer with hemorrhage versus chronic gastric ulcer with hemorrhage (K25.4). Acute ulcers typically present with sudden onset bleeding, often NSAID- or stress-related, whereas chronic ulcers imply long-standing mucosal injury with recurrent episodes. This distinction affects DRG assignment, prognosis documentation, and HCC capture strategy.
Code Classification
ICD-10-CM Diagnosis Code — wRVU, assistant payable, and global period fields are not applicable for diagnosis codes. Refer to CPT Procedural Crosswalk (e.g., 43255) and ICD-10-PCS Crosswalk sections for associated procedure coding.
🔍 Code Description
ICD-10-CM K25.0 classifies Acute gastric ulcer with hemorrhage. This code represents an acute mucosal defect in the stomach lining that has eroded into a blood vessel, resulting in active or recent bleeding manifesting as hematemesis, melena, or occult blood loss.
Acute gastric ulcers with hemorrhage are commonly associated with NSAID use, H. pylori infection, physiologic stress (e.g., critical illness), or alcohol. Key clinical terms include hematemesis, melena, and acute posthemorrhagic anemia; link to K92.0 or D62 when documented.
🌳 Code Tree / Hierarchy
K25 — Gastric ulcer ❌ Non-billable
│
├── K25.0 — Acute gastric ulcer with hemorrhage ◀ THIS CODE ✅ Billable
├── K25.1 — Acute gastric ulcer with perforation ✅ Billable
├── K25.2 — Acute gastric ulcer with both hemorrhage and perforation ✅ Billable
├── K25.3 — Acute gastric ulcer without hemorrhage or perforation ✅ Billable
│
├── K25.4 — Chronic gastric ulcer with hemorrhage ✅ Billable
├── K25.5 — Chronic gastric ulcer with perforation ✅ Billable
├── K25.6 — Chronic gastric ulcer with both hemorrhage and perforation ✅ Billable
├── K25.7 — Chronic gastric ulcer without hemorrhage or perforation ✅ Billable
│
└── K25.9 — Gastric ulcer, unspecified as to whether acute or chronic, without hemorrhage or perforation ✅ Billable
"With Hemorrhage" Drives DRG and Severity Capture
Selecting K25.0 over K25.3 (acute without hemorrhage) is critical for accurate DRG assignment to the GI hemorrhage family (DRG 378-380), which carries higher relative weights. Payers may require endoscopic or laboratory evidence of bleeding to support the “with hemorrhage” specificity.
✅ Includes
The following clinical terms and scenarios map to K25.0 when documented:
- Acute bleeding gastric ulcer
- Acute gastric ulcer with hematemesis
- Acute gastric ulcer with melena
- Acute peptic ulcer of stomach with documented hemorrhage
- Hemorrhagic gastritis with acute ulceration and bleeding
❌ Excludes
Excludes 1 — Cannot Be Coded Simultaneously with K25.0
| Code | Description | Note |
|---|---|---|
| K25.4 | Chronic gastric ulcer with hemorrhage | Acute and chronic classifications are mutually exclusive per Excludes1; query provider if documentation lacks temporal specificity |
| K26.0 | Acute duodenal ulcer with hemorrhage | Different anatomic site (duodenum vs. stomach); code based on endoscopic or imaging localization |
| K27.0 | Acute peptic ulcer, site unspecified, with hemorrhage | Use only if site cannot be determined after study; prefer site-specific code when known |
Excludes 1 Violation Risk
A common error is coding both K25.0 (acute) and K25.4 (chronic) for the same ulcer episode. Per CMS guidelines, acute and chronic are mutually exclusive for the same lesion. If documentation states “acute on chronic,” query for clarification on which phase is being treated during the encounter.
Excludes 2 — May Be Coded in Addition if Separately Present
| Code | Description | Note |
|---|---|---|
| K92.0 | Hematemesis | Code in addition if vomiting of blood is documented as a distinct clinical finding beyond the ulcer diagnosis |
| D62 | Acute posthemorrhagic anemia | Code when significant blood loss from the ulcer results in documented anemia requiring treatment or monitoring |
📋 Clinical Overview
Acute vs. Chronic Gastric Ulcer with Hemorrhage: Key Distinctions
The table below compares acute and chronic gastric ulcer codes with hemorrhage to support accurate code selection based on provider documentation of onset, history, and endoscopic findings.
| Feature | K25.0 — Acute with Hemorrhage | K25.4 — Chronic with Hemorrhage | K25.3 — Acute without Hemorrhage |
|---|---|---|---|
| Onset | Sudden, recent (days to weeks) | Long-standing, recurrent (months to years) | Sudden, recent |
| Endoscopic Appearance | Fresh ulcer base with active bleeding or adherent clot | Fibrotic margins, recurrent bleeding from same site | Ulcer without stigmata of recent hemorrhage |
| Common Etiologies | NSAIDs, acute stress, alcohol, H. pylori (new infection) | Chronic H. pylori, long-term NSAID use, prior ulcer history | NSAIDs, mild stress, early H. pylori |
| DRG Impact | Groups to GI hemorrhage DRGs (378-380) | Same DRG family, but chronicity may affect LOS expectations | Groups to non-bleeding ulcer DRGs (lower weight) |
| HCC Mapping | HCC 179 (acute encounter only) | HCC 179 (if acute hemorrhagic episode documented) | Not HCC-mapped for hemorrhage |
CDI Query Trigger — Unclear Acuity or Hemorrhage Status
When documentation states “bleeding gastric ulcer” or “ulcer with hemorrhage” without specifying acute vs. chronic, or when endoscopy reports ulcer without clear stigmata of recent bleed, trigger a query: “Please clarify: (1) Is the gastric ulcer acute or chronic? (2) Is active or recent hemorrhage documented (hematemesis, melena, drop in Hgb, endoscopic stigmata)?” This ensures selection of K25.0 vs. K25.4 or K25.3.
Manifestations & Symptom Burden
Common presenting symptoms and associated manifestations for acute gastric ulcer with hemorrhage: Hematemesis: Vomiting of bright red or coffee-ground blood, indicating upper GI bleeding
- Melena: Black, tarry stools resulting from digested blood passing through the GI tract
- Acute posthemorrhagic anemia: Documented hemoglobin drop, fatigue, tachycardia secondary to blood loss
- Epigastric pain: Burning or gnawing pain, often worsened by meals or NSAID use
Coding Manifestations
Always code the documented manifestations to fully capture the patient’s complexity. Examples include: K92.0 — Hematemesis (if documented as distinct finding) D62 — Acute posthemorrhagic anemia (if Hgb drop requires intervention) R10.13 — Epigastric pain (if pain is a focus of evaluation beyond the ulcer diagnosis)
💰 HCC Risk Adjustment (CMS-HCC v28)
| Field | Detail |
|---|---|
| CMS-HCC Model Version | v28 (2024-2025 Implementation) |
| HCC Assignment | ✅ Mapped — HCC 179 |
| HCC Category | HCC 179 — Upper GI Hemorrhage |
| RAF Coefficient | ~0.30-0.40 (varies by demographic/status) |
ICD-10 CM K25.0 maps to HCC 179 (Upper GI Hemorrhage) and contributes to the RAF score during the encounter year when acute bleeding is treated.
Acute Condition — Capture During Active Episode Only
Unlike chronic HCC-mapped conditions, K25.0 is an acute diagnosis. It contributes to risk adjustment only in the year the acute hemorrhagic episode occurs and is treated. Do not carry forward to subsequent years unless a new acute hemorrhagic gastric ulcer is documented and managed. Ensure documentation supports “acute” and “with hemorrhage” to justify HCC capture.
🏥 MS-DRG Assignment
MDC 06 — Diseases and Disorders of the Digestive System
| DRG | Title | Est. Relative Weight* |
|---|---|---|
| DRG 378 | GI hemorrhage with MCC | ~1.85 - 2.15 |
| DRG 379 | GI hemorrhage with CC | ~1.15 - 1.45 |
| DRG 380 | GI hemorrhage without CC/MCC | ~0.75 - 0.95 |
Approximate. Verify against IPPS FY2026 Final Rule tables.
Sequencing and Complications
When K25.0 is the reason for admission (e.g., patient presents with hematemesis and EGD confirms acute bleeding gastric ulcer), sequence as principal diagnosis to assign to DRG 378-380. When sequenced secondarily (e.g., patient admitted for sepsis, and acute gastric ulcer with bleed is a comorbidity), K25.0 typically functions as a CC (not MCC), adding moderate payment adjustment if POA=Y.
Common complications that may elevate to MCC status include D62 with severe anemia requiring transfusion, R57.1 hypovolemic shock, or N17.9 acute kidney injury from hypoperfusion.
🔗 Related ICD-10-CM Codes
Progression / Complication Variants
| Code | Description |
|---|---|
| K25.0 | Acute gastric ulcer with hemorrhage ← This Code |
| 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 |
Chronic / Recurrent Variants
| Code | Description |
|---|---|
| K25.4 | Chronic gastric ulcer with hemorrhage |
| K25.5 | Chronic gastric ulcer with perforation |
| K25.6 | Chronic gastric ulcer with both hemorrhage and perforation |
| K25.7 | Chronic gastric ulcer without hemorrhage or perforation |
🛠️ Commonly Associated CPT Codes (Gastroenterology / Outpatient Endoscopy)
Outpatient and Profee Setting Context
These CPT codes represent endoscopic procedures commonly performed to diagnose and treat acute gastric ulcer with hemorrhage in the outpatient or ASC setting. Modifier -26 may be appended for professional component billing when facility reports technical component.
| CPT Code | Description | Profee Coding Notes (Modifier 26) |
|---|---|---|
| 43255 | EGD with control of bleeding, any method | Primary therapeutic code for endoscopic hemostasis of bleeding ulcer; bundles diagnostic EGD |
| 43239 | EGD with biopsy, single or multiple | Report if biopsy is performed on ulcer margin; bundles with 43255 unless distinct lesion biopsied |
| 43235 | EGD, diagnostic, collection of specimen(s) | Use only if no therapeutic intervention performed; bundles with 43255 if hemostasis done |
| 43248 | EGD with insertion of intraluminal tube/catheter | Report if decompression tube placed for gastric outlet obstruction secondary to ulcer |
NCCI Bundling Considerations
CPT 43255 (therapeutic EGD with hemostasis) billed on the same day as 43235 (diagnostic EGD) is bundled per NCCI; do not report both unless separate, distinct lesions are evaluated. If a diagnostic exam of a different anatomic site (e.g., duodenum) is performed, append Modifier -59 to 43235. Biopsy (43239) is bundled with therapeutic EGD (43255) unless performed on a separate, unrelated lesion.
🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)
When K25.0 is an inpatient diagnosis, these PCS codes are relevant for associated inpatient procedures.
| PCS Section | Body System | Root Operation | Clinical Application |
|---|---|---|---|
| 0 (Medical and Surgical) | D (Gastrointestinal System) | Q (Control) | Endoscopic control of gastric bleeding: 0WQG8ZZ (Control bleeding in stomach, via natural or artificial opening endoscopic) |
| 0 (Medical and Surgical) | D (Gastrointestinal System) | B (Excision) | Endoscopic biopsy of bleeding ulcer: 0DB68ZX (Excision of stomach, via natural or artificial opening endoscopic, diagnostic) |
| 3 (Administration) | E (Physiological Systems) | 0 (Introduction) | Transfusion of packed red blood cells for anemia secondary to bleed: 30233N1 (Transfuse nonautologous red blood cells into peripheral vein, percutaneous approach) |
💊 Coding Scenarios and Examples
Scenario 1 — Outpatient GI Clinic: Acute Bleeding Ulcer Managed Endoscopically
Clinical Vignette: 68-year-old male presents to GI clinic with 2 days of coffee-ground emesis and epigastric pain. History of chronic ibuprofen use for osteoarthritis. EGD reveals a 1.5 cm antral ulcer with active oozing and adherent clot. Epinephrine injection and hemoclips achieve hemostasis. Biopsy confirms benign ulcer, H. pylori negative.
Principal Diagnosis: K25.0 — Acute gastric ulcer with hemorrhage (reason for encounter; endoscopic confirmation of acute ulcer with bleeding)
Secondary Diagnoses: D62 — Acute posthemorrhagic anemia (Hgb dropped from 14.2 to 10.8 g/dL; required iron supplementation) K92.0 — Hematemesis (documented as distinct presenting symptom)
CPT Codes (Profee): 43255 — EGD with control of bleeding (therapeutic intervention for hemorrhage) 43239 — EGD with biopsy (bundled per NCCI; not separately reportable with 43255 unless distinct lesion)
Scenario 2 — Inpatient Admission: GI Hemorrhage with Comorbidities
Clinical Vignette: 72-year-old female admitted via ED with melena, orthostasis, and Hgb 7.9 g/dL. Past medical history significant for hypertension and CKD stage 3. EGD confirms acute gastric ulcer with visible vessel; hemostasis achieved. Patient receives 2 units PRBCs, IV PPI infusion, and is monitored on telemetry.
Principal Diagnosis: K25.0 — Acute gastric ulcer with hemorrhage (reason for admission; acute bleed requiring inpatient management)
Secondary Diagnoses:
D62 — Acute posthemorrhagic anemia (CC; requires transfusion and monitoring) I10 — Essential hypertension (chronic comorbidity; POA=Y) N18.3 — Chronic kidney disease, stage 3 (moderate) (CC; impacts medication dosing and prognosis)
MS-DRG Assignment: Principal diagnosis K25.0 assigns to MDC 06. Secondary diagnoses D62 and N18.3 both qualify as CCs. Claim groups to DRG 379 (GI hemorrhage with CC), relative weight ~1.3. If severe anemia with hemodynamic instability were documented, R57.1 hypovolemic shock (MCC) could elevate to DRG 378.
Scenario 3 — CDI Query: Unclear Acuity and Hemorrhage Documentation
Clinical Vignette: 55-year-old male admitted for abdominal pain. Discharge summary states “gastric ulcer with bleeding” but does not specify acute vs. chronic. EGD report describes “ulcer with stigmata of recent hemorrhage” but provider progress notes lack temporal language.
Action / Outcome:
- Documentation gap: “bleeding gastric ulcer” lacks specificity for acute vs. chronic classification, creating uncertainty between K25.0 and K25.4. Additionally, “bleeding” is vague—does it meet criteria for “with hemorrhage” (active bleed, hematemesis, melena, Hgb drop) or is it historical?
- Query Sent: “Per ICD-10-CM guidelines, gastric ulcer codes require specification of acute vs. chronic and presence of hemorrhage/perforation. Please clarify: (1) Is the gastric ulcer acute or chronic? (2) Is active or recent hemorrhage documented (e.g., hematemesis, melena, endoscopic stigmata, Hgb decline)?”
Query Response: Provider updates documentation to confirm: “Acute gastric ulcer with active hemorrhage, managed with endoscopic hemostasis.”
Corrected ICD-10-CM Coding: K25.0 — Acute gastric ulcer with hemorrhage (final accurate code after CDI clarification) K92.0 — hematemesis (supporting manifestation, if documented)
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Using unspecified code K25.9 when hemorrhage is documented. Consequence: Misses DRG assignment to GI hemorrhage family and underrepresents severity. Always query for “with hemorrhage” specificity when bleeding is evident. |
| ❌ | Coding both acute K25.0 and chronic K25.4 for the same ulcer episode. Consequence: Excludes1 violation; claim may be rejected or downcoded. Acute and chronic are mutually exclusive per CMS guidelines. |
| ✅ | Always link hemorrhage manifestations: When K25.0 is coded, also report K92.0 (hematemesis) or D62 (anemia) if documented. This fully captures clinical complexity and supports CC/MCC assignment. |
| ✅ | Document POA explicitly for HAC-prone complications: If acute ulcer with hemorrhage is present on admission, ensure “present on admission” is stated in H&P to support POA=Y and avoid HAC payment adjustments for any associated complications. |
| ✅ | Query for acuity when documentation is ambiguous: Terms like “bleeding ulcer” or “ulcer with hemorrhage” require clarification of acute vs. chronic to select the correct 4th character. A simple query prevents DRG misassignment and audit risk. |
📚 Sources
CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2026. American College of Gastroenterology. ACG Clinical Guideline: Diagnosis and Management of Peptic Ulcer Disease (2023 Update). Laine, L., & Jensen, D. M. (2021). Management of patients with ulcer bleeding. American Journal of Gastroenterology, 116(3), 493-508. (Source for endoscopic stigmata and hemorrhage management.) CMS. 2025-2026 Medicare Advantage Risk Adjustment — CMS-HCC Model v28 ICD-10-CM Mappings. CMS. IPPS Final Rule FY2026 — MS-DRG Definitions Manual v43. MDC 06 logic tables. AMA. CPT Professional Edition 2026. Surgery / Digestive System subsection.