K25.6

HCC Category Mapping

What This Code Means

A chronic or long-standing stomach ulcer that is both bleeding internally and has perforated through the stomach wall, representing a severe dual complication.

Coding Tips

• •This code requires documentation of both hemorrhage AND perforation; if only one complication is present, use a different code
• •This is a high-severity condition often requiring surgical intervention; ensure all complications are captured in coding

Clinical Significance

Chronic or unspecified gastric ulcer with both hemorrhage and perforation is the most severe chronic ulcer presentation, combining active bleeding with full-thickness wall penetration. This dual complication in a chronic ulcer often reflects refractory disease or treatment failure, indicating significant resource needs. Capturing both complications is essential for accurate severity reporting.

Documentation Requirements

• ✓Provider documentation confirming BOTH hemorrhage AND perforation in a chronic or unspecified gastric ulcer
• ✓Evidence of active hemorrhage (endoscopic findings, melena, hemoglobin trends)
• ✓Evidence of perforation (free air, peritoneal signs, operative findings)
• ✓Chronicity or unspecified nature of the ulcer documented
• ✓Location confirmed as gastric
• ✓Intervention documentation for both hemorrhage control and perforation repair

Commonly Confused Codes