What is ICD-10 code K26.2?

K26.2 is the ICD-10-CM diagnosis code for Acute duodenal ulcer with both hemorrhage and perforation. A newly developed duodenal ulcer that is both actively bleeding and has perforated through the duodenal wall, representing a critical dual complication. K26.2 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. K26.2 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. K26.2 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. K26.2 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 K26.2 map to under V28?

K26.2 maps to CMS-HCC V28 HCC 78 (Intestinal Obstruction/Perforation). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

What documentation supports K26.2?

This code requires documentation of BOTH hemorrhage AND perforation; verify both complications are present before coding This is a life-threatening condition requiring immediate surgical intervention; ensure severity is reflected in documentation Because K26.2 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM K26.2: Acute duodenal ulcer

K26.2 maps to CMS-HCC V28 78. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupK26.2Effective 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)

K26.2

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

Acute duodenal ulcer with both hemorrhage and perforation

A newly developed duodenal ulcer that is both actively bleeding and has perforated through the duodenal wall, representing a critical dual complication.

Buddy Insight

Acute duodenal ulcer with both hemorrhage and perforation is a life-threatening dual complication representing the most severe acute duodenal ulcer presentation.

CMS-HCC V28

Mapped

HCC 78

Intestinal Obstruction/Perfor...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 042

HHS-HCC 042 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 33

Intestinal Obstruction/Perfor...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

K26Duodenal ulcer

K26.2Acute duodenal ulcer with both hemorrhage and perforation

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for K26.2 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for K26.2 in this effective period.

Related Child Codes

Official

K26.0Acute duodenal ulcer with hemorrhage

K26.1Acute duodenal ulcer with perforation

K26.3Acute duodenal ulcer without hemorrhage or perforation

K26.4Chronic or unspecified duodenal ulcer with hemorrhage

K26.5Chronic or unspecified duodenal ulcer with perforation

Includes

Official

erosion (acute) of duodenum
duodenum ulcer (peptic)
postpyloric ulcer (peptic)

Excludes 1

Official

peptic ulcer NOS (K27.-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for K26.2 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 K26.2 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation confirming BOTH hemorrhage AND perforation simultaneously

Evidence of active hemorrhage (hematemesis, melena, hemodynamic instability, transfusion needs)

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

Acuity confirmed as acute

MEAT Support

HCC Buddy guidance

Provider documentation confirming BOTH hemorrhage AND perforation simultaneously

Evidence of active hemorrhage (hematemesis, melena, hemodynamic instability, transfusion needs)

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

Acuity confirmed as acute

Audit Caution

HCC Buddy guidance

Assigning K26.0 or K26.1 when documentation supports both complications — always use the combination code K26.2

Not confirming both complications are documented before using this high-specificity code

Confusing anatomic site — verify duodenal vs. gastric location

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

Common Mistakes

HCC Buddy guidance

K26.0 — Acute duodenal ulcer with hemorrhage: hemorrhage only, no perforation

K26.1 — Acute duodenal ulcer with perforation: perforation only, no hemorrhage

K26.6 — Chronic or unspecified duodenal ulcer with both hemorrhage and perforation: chronic or unspecified acuity

K25.2 — Acute gastric ulcer with both hemorrhage and perforation: gastric, not duodenal 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 K26.2 an HCC code?

Yes. K26.2 (Acute duodenal ulcer with both hemorrhage and perforation) maps to HCC 78, Intestinal Obstruction/Perforation under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.326. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: K26.2 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: K26.2
Description: Acute duodenal ulcer with both hemorrhage and perforation
HCC (V28): HCC 78 — Intestinal Obstruction/Perforation
RAF reference coefficient: 0.326
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 78, Intestinal Obstruction/Perforation

0.326

ESRDHCC 33, Intestinal Obstruction/Perforation

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work K26.2 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for K26.2

For K26.2 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 K26.2 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

K26.2 is the ICD-10-CM diagnosis code for acute duodenal ulcer with both hemorrhage and perforation. A newly developed duodenal ulcer that is both actively bleeding and has perforated through the duodenal wall, representing a critical dual complication. K26.2 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, K26.2 maps to Intestinal Obstruction/Perforation (HCC 78) with a source-labeled community, non-dual, aged reference coefficient of 0.326. No V24 mapping is shown for K26.2; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

This code requires documentation of BOTH hemorrhage AND perforation; verify both complications are present before coding. Because K26.2 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for K26.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code requires documentation of BOTH hemorrhage AND perforation; verify both complications are present before coding
•This is a life-threatening condition requiring immediate surgical intervention; ensure severity is reflected in documentation

Clinical Significance

Acute duodenal ulcer with both hemorrhage and perforation is a life-threatening dual complication representing the most severe acute duodenal ulcer presentation. The simultaneous bleeding and perforation creates a complex surgical emergency requiring both hemorrhage control and closure of the duodenal defect. This condition carries the highest morbidity among duodenal ulcer complications.

Documentation Requirements

✓Provider documentation confirming BOTH hemorrhage AND perforation simultaneously
✓Evidence of active hemorrhage (hematemesis, melena, hemodynamic instability, transfusion needs)
✓Evidence of perforation (free air on imaging, peritoneal signs, operative findings)
✓Acuity confirmed as acute
✓Location confirmed as duodenal
✓Documentation of both hemostatic and surgical interventions

Commonly Confused Codes

•K26.0: Acute duodenal ulcer with hemorrhage: hemorrhage only, no perforation
•K26.1: Acute duodenal ulcer with perforation: perforation only, no hemorrhage
•K26.6: Chronic or unspecified duodenal ulcer with both hemorrhage and perforation: chronic or unspecified acuity
•K25.2: Acute gastric ulcer with both hemorrhage and perforation: gastric, not duodenal location