K92.0

🧬 ICD-10-CM K92.0 — Hematemesis

Billable Code Confirmed

ICD-10-CM K92.0 is a valid, billable 4-character ICD-10-CM code for FY2026. The K92 category defines other diseases of the digestive system, and the 0 character specifies the condition strictly as hematemesis. No additional characters are required.

Non-Billable Parent Codes — Never Submit These

• ❌ K92 — 3-character header — Lacks specificity regarding the type or location of the digestive system disease or hemorrhage.

Always submit K92.0 (all 4 characters) when the vomiting of blood is documented and a definitive underlying cause has not been established.

Clinical Context: Symptom vs. Definitive Diagnosis

ICD-10-CM K92.0 captures a clinical sign/symptom. According to ICD-10-CM guidelines, if the underlying etiology of the hematemesis is definitively diagnosed by the provider (e.g., bleeding gastric ulcer, ruptured esophageal varices, or Mallory-Weiss tear), the definitive diagnosis must be coded instead of K92.0. K92.0 is used when the cause of the vomiting of blood remains unknown after clinical evaluation.

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 K92.0 classifies hematemesis. This code represents the regurgitation or vomiting of blood or blood-tinged stomach contents. The clinical presentation varies depending on the briskness of the bleeding; it can appear as bright red blood (indicating active, rapid upper GI bleeding) or as dark, granular material resembling “coffee grounds” (indicating blood that has been altered by gastric acid).

Pathophysiologically, hematemesis confirms that the source of the hemorrhage is located in the upper gastrointestinal tract (proximal to the ligament of Treitz), encompassing the esophagus, stomach, or duodenum. It represents a medical emergency requiring rapid volume resuscitation, possible blood transfusion, and urgent endoscopic evaluation to identify and treat the bleeding source.

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🌳 Code Tree / Hierarchy

K90-K95 Other diseases of the digestive system ❌ Non-billable
│
├── K90 Intestinal malabsorption ❌ Non-billable
├── K91 Postprocedural complications and disorders of digestive system, not elsewhere classified ❌ Non-billable
├── K92 Other diseases of digestive system ❌ Non-billable
│ │
│ ├── K92.0 Hematemesis ◀ THIS CODE ✅ Billable
│ ├── K92.1 Melena ✅ Billable
│ └── K92.2 Gastrointestinal hemorrhage, unspecified ✅ Billable
│
└── K94 Complications of artificial openings of the digestive system ❌ Non-billable

Coding Unspecified GI Bleeds

If a provider documents “Upper GI Bleed” without specifically documenting the clinical manifestation of vomiting blood (hematemesis) or dark stools (melena), the default code is K92.2 (Gastrointestinal hemorrhage, unspecified). Query the provider if the clinical picture suggests hematemesis to secure the more specific K92.0 code.

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✅ Includes

The following clinical terms and scenarios map to K92.0 when documented:

• Hematemesis NOS

• Vomiting of blood

• Coffee-ground emesis

• Vomiting fresh bright red blood from an upper GI source

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❌ Excludes

Excludes 1 — Cannot Be Coded Simultaneously with K92.0

Code	Description	Note
K92.2	Gastrointestinal hemorrhage, unspecified	Mutually exclusive. Hematemesis specifies the nature of the hemorrhage. Never code an unspecified hemorrhage code alongside a specific one for the same clinical event.
K25.0-K28.0	Peptic ulcer with hemorrhage	Mutually exclusive. If the hematemesis is definitively proven to be caused by a bleeding ulcer, code the ulcer. The symptom of hematemesis is inherent to the bleeding ulcer.
I85.01	Esophageal varices with bleeding	Mutually exclusive. Ruptured varices are a definitive etiology that completely replaces the symptom code of K92.0.
P54.0	Neonatal hematemesis	Mutually exclusive based on patient age. Use P54.0 strictly for newborns.

Excludes 1 Violation Risk

A frequent error is coding K92.0 alongside an underlying cause like K22.6 (Mallory-Weiss syndrome) or K29.01 (Acute gastritis with bleeding). ICD-10-CM logic dictates that the symptom code (K92.0) must be dropped once the definitive bleeding pathology is established.

Excludes 2 — May Be Coded in Addition if Separately Present

Code	Description	Note
N/A	There are no Excludes 2 notes specifically restricting K92.0.

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📋 Clinical Overview

Phenotype Distinction: GI Bleed Manifestations

Differentiating the physical presentation of the gastrointestinal bleed dictates whether K92.0, K92.1, or lower GI codes are appropriate.

Feature	K92.0 — Hematemesis	K92.1 — Melena	K62.5 — Hemorrhage of rectum
Typical Source	Upper GI (Esophagus, Stomach, Duodenum)	Upper GI or Right Colon	Lower GI (Left Colon, Rectum, Anus)
Appearance	Vomiting bright red blood or coffee-grounds	Black, tarry, foul-smelling stool	Bright red blood per rectum (Hematochezia)
Clinical Speed	Often brisk, rapid transit	Slower transit, allows for digestion of blood	Variable, localized to distal tract

CDI Query Trigger — "UGIB"

“Upper GI Bleed” (UGIB) is a vague diagnostic statement that defaults to K92.2 (unspecified). If the nursing flowsheets and H&P describe the patient vomiting blood or coffee grounds, send a clinical validation query asking the provider to formally document “hematemesis” to capture K92.0.

Manifestations & Symptom Burden

Common systemic manifestations resulting from the blood loss associated with K92.0 include:

• Acute Blood Loss Anemia: Rapid drop in hemoglobin/hematocrit.

• Hypotension & Tachycardia: Signs of hemodynamic instability/hypovolemic shock.

• Syncope: Fainting secondary to acute volume depletion.

Coding Manifestations

Always code the documented systemic effects to fully capture the patient’s severity of illness. Examples include:

• D62 — Acute posthemorrhagic anemia (Often acts as a CC)

• R57.1 — Hypovolemic shock

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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)

K92.0 maps directly to an HCC and contributes to the RAF score.

Capture Annually

While hematemesis is typically an episodic acute event, accurately capturing K92.0 is critical during the encounter where the bleeding occurs. It validates the high resource utilization (transfusions, endoscopies) required for the patient’s care. Always prioritize identifying and coding the underlying chronic etiology (e.g., cirrhosis) for long-term risk adjustment.

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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

K92.0 is correctly sequenced as the principal diagnosis when a patient is admitted for hematemesis, an EGD is performed, and no definitive bleeding source is found (e.g., the bleeding has stopped and the mucosa is normal). If K92.0 develops during a hospital stay for a different condition, it acts as a Complication or Comorbidity (CC), which will shift the DRG to a higher-weighted tier.

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🔗 Related ICD-10-CM Codes

Phenotype Variants

Code	Description
K92.0	Hematemesis ← This Code
K92.1	Melena
K92.2	Gastrointestinal hemorrhage, unspecified

Definitive Etiology Variants (Code instead of K92.0 if known)

Code	Description
K22.6	Gastro-esophageal laceration-hemorrhage syndrome (Mallory-Weiss)
K25.0	Acute gastric ulcer with hemorrhage
K29.01	Acute gastritis with bleeding
I85.01	Esophageal varices with bleeding

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🛠️ Commonly Associated CPT Codes (Outpatient & Profee)

Outpatient and Profee Setting Context

K92.0 provides robust medical necessity for urgent diagnostic and therapeutic esophagogastroduodenoscopy (EGD) procedures.

CPT Code	Description	Profee Coding Notes (Modifier 26)
43235	EGD, flexible, transoral; diagnostic	Billed if the source is evaluated but no intervention is performed.
43255	EGD, flexible, transoral; with control of bleeding, any method	Billed if hemostasis (clips, cautery, epinephrine) is achieved.
36430	Transfusion, blood or blood components	Billed for professional oversight of blood transfusion if criteria are met.

NCCI Bundling Considerations

• 43235 (Diagnostic EGD) billed on the same day as 43255 (Therapeutic EGD for bleeding). The diagnostic portion is bundled into the therapeutic intervention. Report only 43255.

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🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)

When K92.0 is an inpatient diagnosis, these PCS codes are relevant for associated inpatient evaluations and resuscitations.

PCS Section	Body System	Root Operation	Clinical Application
0 (Medical/Surgical)	D (Gastrointestinal System)	J (Inspection)	Bedside or OR diagnostic EGD to locate the source of hematemesis: 0DJ08ZZ (Inspection of Upper Intestinal Tract, Via Natural or Artificial Opening Endoscopic).
3 (Administration)	0 (Circulatory)	2 (Transfusion)	PRBC transfusion via peripheral IV for acute blood loss: 30233N1 (Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Percutaneous Approach).

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💊 Coding Scenarios and Examples

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Scenario 1 — ED to Inpatient Admission: Undetermined Source

Clinical Vignette: A 42-year-old male presents to the ED with two episodes of large-volume coffee-ground emesis and dizziness. He is admitted to the medical floor and transfused 1 unit of PRBCs. A GI consult performs an urgent EGD, which shows normal esophageal, gastric, and duodenal mucosa with no active bleeding or identifiable stigmata of recent hemorrhage. The bleeding resolves spontaneously. The provider’s final diagnosis is “Resolved upper GI bleed presenting as hematemesis, source undetermined.”

Principal Diagnosis:

• K92.0 — Hematemesis (The definitive symptom that prompted admission; a specific etiology could not be found after study).

Secondary Diagnoses:

• D62 — Acute posthemorrhagic anemia (Condition supported by dizziness, blood transfusion, and clinical context; acts as a CC).

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Scenario 2 — Inpatient Complication: Excludes 1 Application

Clinical Vignette: A 68-year-old female is admitted for treatment of a DVT and started on a continuous heparin infusion. On hospital day 2, she develops acute hematemesis. Her heparin is paused, and an emergent EGD is performed. The endoscopist identifies a 1.5 cm actively bleeding acute gastric ulcer. Hemostasis is achieved with hemoclips.

Principal Diagnosis:

• I80.209 — Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremity (Reason for admission)

Secondary Diagnoses:

• K25.0 — Acute gastric ulcer with hemorrhage (Condition developed during stay; acts as a CC. Note: K92.0 is NOT coded because the definitive cause of the bleeding—the ulcer—was found).

• Y41.2 — Anticoagulants causing adverse effects in therapeutic use (To capture the heparin involvement).

MS-DRG Assignment: Groups to DRG 294 (Deep Vein Thrombophlebitis with CC), due to the acute bleeding gastric ulcer elevating the severity.

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Scenario 3 — CDI Query: Vague “UGIB” Documentation

Clinical Vignette: The ED provider admits a patient with “Acute UGIB.” The H&P notes the patient had “several bouts of vomiting blood at home.” An EGD is inconclusive. The discharge summary lists the final diagnosis simply as “Upper GI Bleed.”

Action / Outcome:

Coding strictly from “Upper GI Bleed” assigns K92.2 (Gastrointestinal hemorrhage, unspecified). However, the H&P contains explicit clinical evidence of hematemesis. A clinical validation query should be sent to the attending provider to incorporate the specific physical manifestation into the final diagnostic statement to ensure optimal specificity and HCC/DRG mapping.

Query Response: Provider updates the discharge summary to state: “Upper GI Bleed presenting as hematemesis.”

Corrected ICD-10-CM Coding:

• K92.0 — Hematemesis (Accurately captures the specific symptom documented in the clinical course).

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⚠️ Coding Pitfalls and Tips

	Pitfall or Tip
❌	Coding Hematemesis with the Underlying Cause. Do not assign K92.0 if the provider’s final diagnosis definitively identifies the bleeding source (e.g., Mallory-Weiss tear, esophageal varices, gastric ulcer). ICD-10-CM guidelines dictate coding only the definitive diagnosis.
❌	Defaulting to K92.2. Avoid using K92.2 (Unspecified GI Hemorrhage) if the medical record clearly describes the patient vomiting blood. Query the provider to formally diagnose “hematemesis” for greater specificity.
✅	Code Systemic Manifestations. Hematemesis frequently results in acute blood loss anemia. Always review the lab values (Hgb/Hct) and transfusion records. If acute posthemorrhagic anemia is documented, add D62 to accurately reflect the patient’s severity of illness and potentially secure a CC.
✅	Look for External Causes. If the hematemesis is documented as an adverse effect of a prescribed medication (like NSAIDs, anticoagulants, or steroids), assign the appropriate Adverse Effect (Y-code) as a secondary diagnosis.

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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.