Chronic or unsp gastric ulcer w both hemorrhage and perf

This code signifies a long-standing or unstated gastric ulcer that has simultaneously eroded through the stomach wall (perforation) and caused bleeding (hemorrhage). This represents a severe complication of peptic ulcer disease, requiring urgent medical or surgical intervention.

Apply this code when documentation clearly indicates a gastric ulcer, either chronic or not specified as acute, presenting with evidence of both active bleeding (e.g., hematemesis, melena, positive occult blood, or endoscopic findings) and a full-thickness defect in the gastric wall. Supporting documentation includes operative reports, endoscopy reports, and physician notes detailing both complications.

• Differentiate carefully between acute and chronic ulcers; this code is specific to chronic or unspecified.
• Ensure both hemorrhage and perforation are explicitly documented as present; do not assume one from the other.
• Avoid using this code if only one of the complications (hemorrhage or perforation) is present; separate codes exist for each.