K26.0

🧬 ICD-10-CM K26.0 — Acute Duodenal Ulcer With Hemorrhage

Billable Code Confirmed

ICD-10-CM K26.0 is a valid, billable 4-character ICD-10-CM code for FY2026. The K26 category defines duodenal ulcers, and the 0 character specifies the condition as acute with active or recent hemorrhage. No additional characters are required.

Non-Billable Parent Codes — Never Submit These

• ❌ K26 — 3-character header — Lacks specificity regarding acuity, hemorrhage, and perforation status.

Always submit K26.0 (all 4 characters) when an acute bleeding ulcer in the duodenum is documented.

Clinical Context: Anatomical Specificity

ICD-10 CM K26.0 captures bleeding specifically in the duodenum (postpyloric). This must be distinguished from gastric (stomach) ulcers (K25.-). If an endoscopy report indicates an ulcer in the “duodenal bulb” or “first portion of the duodenum” with active oozing or a visible vessel, this is the correct code.

Code Classification

ICD-10-CM Diagnosis Code — wRVU, assistant payable, and global period fields are not applicable; direct reader to CPT Procedural Crosswalk and ICD-10-PCS Crosswalk sections.

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🔍 Code Description

ICD-10 CM K26.0 classifies acute duodenal ulcer with hemorrhage. This code represents an abrupt and potentially life-threatening breach in the mucosal lining of the duodenum that has eroded into an underlying blood vessel, causing active upper gastrointestinal bleeding.

Pathophysiologically, acute duodenal ulcers are most commonly associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The high acidity of gastric contents emptying into the duodenum exacerbates the mucosal damage. When bleeding occurs, patients require immediate medical management, fluid resuscitation, and typically an urgent esophagogastroduodenoscopy (EGD) to achieve hemostasis.

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🌳 Code Tree / Hierarchy

K20-K31 Diseases of esophagus, stomach and duodenum ❌ Non-billable
│
├── K25 Gastric ulcer ❌ Non-billable
├── K26 Duodenal ulcer ❌ Non-billable
│ │
│ ├── K26.0 Acute duodenal ulcer with hemorrhage ◀ THIS CODE ✅ Billable
│ ├── K26.1 Acute duodenal ulcer with perforation ✅ Billable
│ ├── K26.2 Acute duodenal ulcer with both hemorrhage and perforation ✅ Billable
│ └── K26.3 Acute duodenal ulcer without hemorrhage or perforation ✅ Billable
│
└── K27 Peptic ulcer, site unspecified ❌ Non-billable

Specificity and the 4th Character

The 4th character in this category is critical for DRG optimization and medical necessity. Capturing the hemorrhage (0 or 2) elevates the severity of illness significantly compared to an uncomplicated ulcer (3).

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✅ Includes

The following clinical terms and scenarios map to K26.0 when documented:

• Acute erosion of duodenum with hemorrhage

• Acute duodenal (peptic) ulcer with bleeding

• Acute postpyloric ulcer with hemorrhage

• Bleeding ulcer in the duodenal bulb

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❌ Excludes

Excludes 1 — Cannot Be Coded Simultaneously with K26.0

Code	Description	Note
K27.-	Peptic ulcer, site unspecified	Mutually exclusive. If the site is confirmed as the duodenum (K26.0), the unspecified “peptic ulcer” code cannot be used simultaneously.

Excludes 1 Violation Risk

Do not assign K27.0 (Acute peptic ulcer, unspecified site) if an EGD report definitively identifies the ulcer location in the duodenum. Always code to the highest level of anatomical specificity available.

Excludes 2 — May Be Coded in Addition if Separately Present

Code	Description	Note
N/A	There are no Excludes 2 notes restricting K26.0.

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📋 Clinical Overview

Phenotype Distinction: Duodenal Ulcer Acuity

This table differentiates the acute presentations of duodenal ulcers, dictating the medical necessity for surgical vs. endoscopic interventions.

Feature	K26.0 — With Hemorrhage	K26.1 — With Perforation	K26.3 — Uncomplicated
Mucosal Status	Eroded into blood vessel	Full-thickness breach	Intact ulcer base, no active bleeding
Primary Symptoms	Hematemesis, melena, symptomatic anemia	Severe, sudden abdominal pain, rigid abdomen	Epigastric pain (often relieved by food)
Typical Intervention	Urgent EGD with hemostasis	Emergent surgical repair	Medical management (PPI therapy)

Documentation Tip — "Code First" Requirements

The ICD-10-CM guidelines for the K20-K31 block contain an instructional note to “Use additional code to identify: alcohol abuse and dependence (F10.-).” If the provider documents that the bleeding ulcer is exacerbated by active alcohol dependence, ensure the appropriate F10.- code is added.

Manifestations & Symptom Burden

Common presenting symptoms that support the clinical validation of K26.0 include:

• Melena: Black, tarry, foul-smelling stools indicating digested blood from an upper GI source.

• hematemesis: Vomiting of bright red blood or “coffee-ground” material.

• Acute Blood Loss Anemia: Rapid drop in hemoglobin/hematocrit leading to tachycardia, hypotension, or syncope.

Coding Manifestations

Always code the documented manifestations to fully capture the patient’s complexity. Examples include:

• D62 — Acute posthemorrhagic anemia (Sequence as secondary if a blood transfusion was required)

• R55 — Syncope and collapse

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💰 HCC Risk Adjustment (CMS-HCC v28)

Field	Detail
CMS-HCC Model Version	v28 (2024-2025 Implementation)
HCC Assignment	✅ Mapped — HCC 151
HCC Category	HCC 151 — Gastrointestinal Hemorrhage
RAF Coefficient	~0.25 - 0.35 (varies by demographic/status)

K26.0 maps directly to an HCC and contributes to the RAF score.

Capture Annually

While acute bleeding is an episodic event rather than a chronic disease, it is critical to capture K26.0 accurately during the encounter where the bleeding occurs. It accurately reflects a sharp spike in resource utilization and severity of illness for the patient’s risk profile in that calendar year.

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🏥 MS-DRG Assignment

MDC 06 — Diseases and Disorders of the Digestive System

DRG	Title	Est. Relative Weight*
DRG 377	G.I. Hemorrhage with MCC	~1.65
DRG 378	G.I. Hemorrhage with CC	~0.95
DRG 379	G.I. Hemorrhage without CC/MCC	~0.65

Approximate. Verify against IPPS FY2026 Final Rule tables.

Sequencing and Complications

K26.0 is a frequent principal diagnosis for patients admitted from the ED with melena or hematemesis. If a patient is admitted for a different condition (e.g., sepsis) and develops an acute GI bleed requiring endoscopy during the stay, K26.0 is sequenced secondarily and acts as a Complication or Comorbidity (CC), elevating the DRG weight.

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🔗 Related ICD-10-CM Codes

Progression / Exacerbation Variants

Code	Description
K26.0	Acute duodenal ulcer with hemorrhage ← This Code
K26.2	Acute duodenal ulcer with both hemorrhage and perforation
K26.4	Chronic or unspecified duodenal ulcer with hemorrhage

Anatomical Site Variants

Code	Description
K25.0	Acute gastric ulcer with hemorrhage
K27.0	Acute peptic ulcer, site unspecified, with hemorrhage
K28.0	Acute gastrojejunal ulcer with hemorrhage

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🛠️ Commonly Associated CPT Codes (Outpatient & Profee)

Outpatient and Profee Setting Context

K26.0 provides the primary medical necessity for urgent upper endoscopies. Procedures will typically involve therapeutic mechanisms to control active bleeding or prevent re-bleeding from a visible vessel.

CPT Code	Description	Profee Coding Notes (Modifier 26)
43255	EGD, flexible, transoral; with control of bleeding, any method	Standard therapeutic code for managing the bleeding ulcer (clips, cautery, epi injection).
43235	EGD, flexible, transoral; diagnostic	Billed only if no therapeutic intervention/biopsy was required.
43239	EGD, flexible, transoral; with biopsy, single or multiple	May be billed if a biopsy was taken to test for H. pylori.

NCCI Bundling Considerations

• 43235 (Diagnostic EGD) billed on the same day as 43255 (EGD with control of bleeding). The diagnostic scope is inherently bundled into the therapeutic intervention. Report only 43255.

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🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)

When K26.0 is an inpatient diagnosis, these PCS codes are relevant for associated inpatient procedures performed to achieve hemostasis.

PCS Section	Body System	Root Operation	Clinical Application
0 (Medical/Surgical)	D (Gastrointestinal System)	5 (Destruction)	Endoscopic electrocoagulation or argon plasma coagulation (APC) of the bleeding ulcer: 0D598ZZ (Destruction of Duodenum, Via Natural or Artificial Opening Endoscopic).
0 (Medical/Surgical)	D (Gastrointestinal System)	W (Restriction)	Endoscopic placement of hemoclips on a visible vessel in the duodenal bulb: 0DW98XZ (Restriction of Duodenum with Intraluminal Device, Via Natural or Artificial Opening Endoscopic).

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💊 Coding Scenarios and Examples

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Scenario 1 — ED / Inpatient Admission: Primary Presentation

Clinical Vignette: A 55-year-old male presents to the ED with weakness, dizziness, and two episodes of large-volume melena. Initial labs show a hemoglobin of 6.8 g/dL. He is admitted to the ICU and resuscitated with 2 units of packed RBCs. An urgent EGD is performed, revealing a 2 cm acute ulcer with active spurting bleeding in the duodenal bulb. Hemostasis is achieved using epinephrine injection and bipolar electrocoagulation.

Principal Diagnosis:

• K26.0 — Acute duodenal ulcer with hemorrhage (Primary reason for admission)

Secondary Diagnoses:

• D62 — Acute posthemorrhagic anemia (Confirmed by the low hemoglobin and need for transfusion; acts as a CC)

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Scenario 2 — Inpatient Hospitalization: Complication During Stay

Clinical Vignette: A 72-year-old female is admitted for acute exacerbation of COPD and is treated with high-dose IV corticosteroids. On hospital day 3, she develops severe nausea and coffee-ground emesis. A bedside EGD by the GI consult team identifies a newly formed, bleeding acute duodenal ulcer. The bleeding is controlled endoscopically.

Principal Diagnosis:

• J44.1 — Chronic obstructive pulmonary disease with (acute) exacerbation (Reason for admission)

Secondary Diagnoses:

• K26.0 — Acute duodenal ulcer with hemorrhage (Condition developed during the stay; acts as a CC, shifting the MS-DRG to a higher-weighted tier)

• Y42.0 — Glucocorticoids and synthetic analogues causing adverse effects in therapeutic use (To capture the external cause of the ulcer formation)

MS-DRG Assignment: Groups to DRG 191 (COPD with CC), as the acute GI hemorrhage elevates the severity level from DRG 192 (without CC/MCC).

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Scenario 3 — CDI Query: Clarifying Anatomy

Clinical Vignette: The ED provider admits a patient with hematemesis and documents “Bleeding peptic ulcer disease.” The gastroenterologist performs an EGD and the procedural note states: “Found a 1 cm oozing ulcer in the first portion of the duodenum. Hemostasis achieved with clips. Impression: UGIB secondary to acute ulcer.” The discharge summary lists “Upper GI Bleed from ulcer.”

Action / Outcome:

Coding strictly from the discharge summary (“Upper GI Bleed from ulcer”) might lead to K27.0 (Acute peptic ulcer, site unspecified). However, the operative report provides specific anatomical detail (duodenum). A clinical validation query should be sent to the attending provider to incorporate the gastroenterologist’s precise finding into the final diagnostic statement.

Query Response: Provider updates the discharge summary to state: “Upper GI Bleed secondary to acute duodenal ulcer.”

Corrected ICD-10-CM Coding:

• K26.0 — Acute duodenal ulcer with hemorrhage (Accurately captures the anatomical site validated by the EGD)

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⚠️ Coding Pitfalls and Tips

	Pitfall or Tip
❌	Defaulting to K92.2 (Gastrointestinal hemorrhage, unspecified). If the provider definitively identifies that the bleeding is originating from a duodenal ulcer, you must code K26.0. Using K92.2 alongside K26.0 is redundant and incorrect.
❌	Missing the Anemia Code. Bleeding ulcers frequently result in acute blood loss anemia. Always review the lab values (Hgb/Hct) and transfusion records. If acute blood loss anemia is documented, add D62 to accurately reflect the patient’s severity of illness.
✅	Code External Causes. If the acute ulcer is documented as being caused by NSAID toxicity, aspirin use, or prescribed steroids, assign the appropriate Adverse Effect code (T-code or Y-code) as a secondary diagnosis.
✅	Differentiate Ulcer History. If an EGD finds an “old, scarred duodenal ulcer” that is not currently bleeding, but the patient was admitted for an unrelated GI bleed, do not use K26.0. Use a code for a chronic/uncomplicated ulcer or personal history, depending on documentation.

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📚 Sources

1. CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2026.

2. American College of Gastroenterology (ACG). Clinical Guidelines: Management of Patients with Ulcer Bleeding.

3. CMS. 2025-2026 Medicare Advantage Risk Adjustment — CMS-HCC Model v28 ICD-10-CM Mappings.

4. CMS. IPPS Final Rule FY2026 — MS-DRG Definitions Manual v43. MDC 06 logic tables.

5. AMA. CPT Professional Edition 2026. Surgery / Digestive System.