Is K26.1 a billable ICD-10-CM code?

Yes. K26.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does K26.1 sit in the tabular list?

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

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.

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.

Medicare coverage

K26.1 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 K26.1 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 K26.1.

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

Related codes at this level

Codes that share K26. If K26.1 is not quite right, the correct code is usually one of these.

Questions about K26.1

Is K26.1 a billable ICD-10-CM code?: Yes. K26.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does K26.1 sit in the tabular list?: Diseases of the digestive system (K00-K95), in the block Diseases of esophagus, stomach and duodenum (K20-K31).