K28.5 — Chronic or unspecified gastrojejunal ulcer with perforation
K28.5 is a billable, specific ICD-10-CM code for chronic or unspecified gastrojejunal ulcer with perforation. It is valid for submission on a claim.
Risk adjustment
K28.5 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
K28.5 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 K28.5 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 K28.5.
- Ulcer, ulcerated, ulcerating, ulceration, ulcerative›gastrojejunal›with›perforation
- Ulcer, ulcerated, ulcerating, ulceration, ulcerative›gastrojejunal›chronic›with›perforation
Related codes at this level
Codes that share K28. If K28.5 is not quite right, the correct code is usually one of these.
- K28.0Acute gastrojejunal ulcer with hemorrhage
- K28.1Acute gastrojejunal ulcer with perforation
- K28.2Acute gastrojejunal ulcer with both hemorrhage and perforation
- K28.3Acute gastrojejunal ulcer without hemorrhage or perforation
- K28.4Chronic or unspecified gastrojejunal ulcer with hemorrhage
- K28.6Chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation
- K28.7Chronic gastrojejunal ulcer without hemorrhage or perforation
- K28.9Gastrojejunal ulcer, unspecified as acute or chronic, without hemorrhage or perforation
Questions about K28.5
- Is K28.5 a billable ICD-10-CM code?
- Yes. K28.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does K28.5 sit in the tabular list?
- Diseases of the digestive system (K00-K95), in the block Diseases of esophagus, stomach and duodenum (K20-K31).