Acute duodenal ulcer with both hemorrhage and perforation

This code signifies an acute ulceration in the duodenum that is actively bleeding and has also created a full-thickness defect through the duodenal wall. This represents a severe, life-threatening complication of peptic ulcer disease requiring urgent medical and often surgical intervention.

Apply this code when documentation clearly indicates an acute duodenal ulcer with concurrent evidence of both hemorrhage (e.g., melena, hematemesis, positive occult blood, or endoscopic visualization of bleeding) and perforation (e.g., free air on imaging, peritonitis, or surgical confirmation). The physician's notes must explicitly state both complications are present and acute.

• Ensure documentation specifies "acute" and clearly identifies both hemorrhage and perforation as present.
• Do not use this code if only one complication (hemorrhage or perforation) is documented, or if the ulcer is chronic.
• Consider sequencing with codes for associated conditions like shock or peritonitis, as appropriate.