What is ICD-10 code K25.2?

K25.2 is the ICD-10-CM diagnosis code for Acute gastric ulcer with both hemorrhage and perforation. A sudden, severe ulcer in the stomach that is both bleeding and has perforated through the stomach wall. It belongs to the ICD-10-CM chapter for diseases of the digestive system (k00-k95). K25.2 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. K25.2 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. K25.2 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. K25.2 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does K25.2 map to under V28?

K25.2 maps to CMS-HCC V28 78 (Intestinal Obstruction/Perforation). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does K25.2 pay in RAF?

K25.2 carries a community, non-dual, aged (CNA) RAF weight of 0.326 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for K25.2?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For K25.2, V28 maps to Intestinal Obstruction/Perforation at RAF 0.326 while V24 mapped to Intestinal Obstruction/Perforation at RAF 0.219. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM K25.2: Acute gastric ulcer

K25.2 maps to CMS-HCC V28 78 (RAF 0.326). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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Code lookupK25.2Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the digestive system (K00-K95) / Diseases of esophagus, stomach and duodenum (K20-K31)

K25.2

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Acute gastric ulcer with both hemorrhage and perforation

A sudden, severe ulcer in the stomach that is both bleeding and has perforated through the stomach wall.

Buddy Insight

Acute gastric ulcer with both hemorrhage and perforation represents the most severe acute ulcer presentation, with simultaneous active bleeding and full-thickness wall penetration.

CMS-HCC V28

Mapped

HCC 78

Intestinal Obstruction/Perfor...

RAF 0.326

CMS-HCC V24

Mapped

HCC 33

Intestinal Obstruction/Perfor...

RAF 0.219

ACA/HHS

Mapped

HCC 42

HHS-HCC 42

Varies by metal level

ESRD/PACE

Mapped

HCC 33

Intestinal Obstruction/Perfor...

RAF 0.078

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

K25Gastric ulcer

K25.2Acute gastric ulcer with both hemorrhage and perforation

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for K25.2 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for K25.2 in this effective period.

Related Child Codes

Official

K25.0Acute gastric ulcer with hemorrhage

K25.1Acute gastric ulcer with perforation

K25.3Acute gastric ulcer without hemorrhage or perforation

K25.4Chronic or unspecified gastric ulcer with hemorrhage

K25.5Chronic or unspecified gastric ulcer with perforation

Includes

Official

erosion (acute) of stomach
pylorus ulcer (peptic)
stomach ulcer (peptic)

Excludes 1

Official

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

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for K25.2 in this effective period.

Use Additional

Official

code to identify:
alcohol abuse and dependence (F10.-)

Code Also

Official

ICD-10-CM does not list Code Also instructions for K25.2 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation confirming BOTH hemorrhage AND perforation are present simultaneously

Evidence of hemorrhage (hematemesis, melena, hemoglobin drop, endoscopic findings)

Evidence of perforation (free air on imaging, peritoneal signs, operative findings)

Acuity documented as acute

MEAT Support

HCC Buddy guidance

Provider documentation confirming BOTH hemorrhage AND perforation are present simultaneously

Evidence of hemorrhage (hematemesis, melena, hemoglobin drop, endoscopic findings)

Evidence of perforation (free air on imaging, peritoneal signs, operative findings)

Acuity documented as acute

Audit Caution

HCC Buddy guidance

Using K25.0 (hemorrhage only) or K25.1 (perforation only) when both complications are documented

Not verifying that BOTH complications are truly present and documented before using this combination code

Failing to query the provider when documentation mentions 'bleeding ulcer with complications' without explicitly stating perforation

Adding separate codes for hemorrhage and perforation when this combination code already captures both

Common Mistakes

HCC Buddy guidance

K25.0 — Acute gastric ulcer with hemorrhage: use when only bleeding is present, no perforation

K25.1 — Acute gastric ulcer with perforation: use when only perforation is present, no hemorrhage

K25.6 — Chronic or unspecified gastric ulcer with both hemorrhage and perforation: different acuity

K26.2 — Acute duodenal ulcer with both hemorrhage and perforation: different anatomic location

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is K25.2 an HCC code?

Yes. K25.2 (Acute gastric ulcer with both hemorrhage and perforation) maps to Intestinal Obstruction/Perforation under the CMS-HCC V28 risk adjustment model (and Intestinal Obstruction/Perforation under V24), with a community non-dual aged RAF of 0.326. It is billable for payment year 2026.

Coder answer: K25.2 is billable and maps to V28 HCC 78, Intestinal Obstruction/Perforation. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: K25.2
Description: Acute gastric ulcer with both hemorrhage and perforation
HCC (V28): HCC 78 — Intestinal Obstruction/Perforation
RAF: 0.326
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 78, Intestinal Obstruction/Perforation

0.326

V24HCC 33, Intestinal Obstruction/Perforation

0.219

ESRDHCC 33, Intestinal Obstruction/Perforation

0.078

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work K25.2 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for K25.2

For K25.2 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed K25.2 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

K25.2 is the ICD-10-CM diagnosis code for acute gastric ulcer with both hemorrhage and perforation. A sudden, severe ulcer in the stomach that is both bleeding and has perforated through the stomach wall. K25.2 sits in the ICD-10-CM chapter for diseases of the digestive system (k00-k95), within the section covering diseases of esophagus, stomach and duodenum (k20-k31).

Under the CMS-HCC V28 risk adjustment model, K25.2 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.326. Under the older V24 model, K25.2 mapped to the same category but with a base RAF weight of 0.219, V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

This represents the most severe acute gastric ulcer presentation requiring urgent intervention. Because K25.2 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for K25.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This represents the most severe acute gastric ulcer presentation requiring urgent intervention
•Document both the hemorrhage management and surgical repair of perforation

Clinical Significance

Acute gastric ulcer with both hemorrhage and perforation represents the most severe acute ulcer presentation, with simultaneous active bleeding and full-thickness wall penetration. This dual complication carries the highest mortality risk among gastric ulcer presentations and requires emergent multi-modal intervention. Accurate capture is critical for reflecting true case severity.

Documentation Requirements

✓Provider documentation confirming BOTH hemorrhage AND perforation are present simultaneously
✓Evidence of hemorrhage (hematemesis, melena, hemoglobin drop, endoscopic findings)
✓Evidence of perforation (free air on imaging, peritoneal signs, operative findings)
✓Acuity documented as acute
✓Location confirmed as gastric (stomach)
✓Documentation of surgical and hemostatic interventions performed

Commonly Confused Codes

•K25.0: Acute gastric ulcer with hemorrhage: use when only bleeding is present, no perforation
•K25.1: Acute gastric ulcer with perforation: use when only perforation is present, no hemorrhage
•K25.6: Chronic or unspecified gastric ulcer with both hemorrhage and perforation: different acuity
•K26.2: Acute duodenal ulcer with both hemorrhage and perforation: different anatomic location