K26.1

K26.1: Acute duodenal ulcer with perforation

Billable / specific codeICD-10-CM

K26.1 is a billable, specific ICD-10-CM code for acute duodenal ulcer with perforation. It is valid for submission on a claim.

Check K26.1 with the rest of the claim: free scrubber

Excludes1 inherited from the categories above K26.1

A category’s note binds every code beneath it.

Written on K26: Duodenal ulcer

peptic ulcer NOS (K27.-)

Other codes that can never be billed with K26.1

Their own Excludes1 notes name this code, so the conflict is not listed above.

K63.1Perforation of intestine (nontraumatic)
K63.3Ulcer of intestine

Risk adjustment

K26.1 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

K26.1 is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

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)

Alphabetic index entries that lead here

Ulcer, ulcerated, ulcerating, ulceration, ulcerative›duodenum, duodenal›acute›with›perforation

Code history

Unchanged in every release from FY2024 to FY2027.