Is K25.5 a billable ICD-10-CM code?

Yes. K25.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does K25.5 sit in the tabular list?

Diseases of the digestive system (K00-K95), in the block Diseases of esophagus, stomach and duodenum (K20-K31).

What cannot be coded together with K25.5?

K25.5 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above K25.5 (K25) and apply to it just the same.

K25.5

K25.5 — Chronic or unspecified gastric ulcer with perforation

Billable / specific codeICD-10-CM

K25.5 is a billable, specific ICD-10-CM code for chronic or unspecified gastric ulcer with perforation. It is valid for submission on a claim.

Excludes1 inherited from the categories above K25.5

These are not written on K25.5, but they bind it: a note on a category applies to every code beneath it. Billing K25.5 with anything listed here is a denial.

Written on K25 — Gastric ulcer

acute gastritis (K29.0-)
peptic ulcer NOS (K27.-)

Other codes that can never be billed with K25.5

These codes carry an Excludes1 note pointing at K25.5. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading K25.5 alone.

K29.0Acute gastritis

Risk adjustment

K25.5 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 78 Intestinal Obstruction/Perforation0.326 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

K25.5 is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56421Billing and Coding: CT of the Abdomen and Pelvis
A57063Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
A57414Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

How K25.5 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to K25.5.

Ulcer, ulcerated, ulcerating, ulceration, ulcerative›stomach›with›perforation
Ulcer, ulcerated, ulcerating, ulceration, ulcerative›stomach›chronic›with›perforation

Code history

K25.5 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share K25. If K25.5 is not quite right, the correct code is usually one of these.

Questions about K25.5

Is K25.5 a billable ICD-10-CM code?: Yes. K25.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does K25.5 sit in the tabular list?: Diseases of the digestive system (K00-K95), in the block Diseases of esophagus, stomach and duodenum (K20-K31).
What cannot be coded together with K25.5?: K25.5 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above K25.5 (K25) and apply to it just the same.