What is the ICD-10 (International Classification of Diseases, 10th Revision) code for a complicated intramural pseudocyst involving the lesser curvature of the stomach with central Hounsfield (HU) attenuation values of 59 HU, as a sequela of intrinsic hemorrhage without active bleeding?

ICD-10 Code for Complicated Intramural Gastric Pseudocyst with Hemorrhagic Sequela

The appropriate ICD-10 code for a complicated intramural pseudocyst involving the lesser curvature of the stomach with central Hounsfield attenuation values of 59 HU, representing sequela of intrinsic hemorrhage without active bleeding, is K86.3 (Pseudocyst of pancreas) with an additional code for the hemorrhagic complication.

Understanding the Condition

• Intramural gastric pseudocyst is a rare entity that forms within the wall of the stomach, often as a complication of pancreatitis 1
• The Hounsfield unit value of 59 is consistent with hemorrhagic content within the pseudocyst, as non-hemorrhagic fluid typically measures between 0-20 HU 2
• This represents a sequela of previous hemorrhage into the pseudocyst without current active bleeding 2

Diagnostic Classification

• The primary code K86.3 (Pseudocyst of pancreas) applies as the base diagnosis 2
• The intramural location in the gastric wall should be specified as an anatomical modifier 1
• The hemorrhagic component (sequela of intrinsic hemorrhage) should be coded as a complication 2, 3

Imaging Characteristics

• CT attenuation values of 59 Hounsfield units indicate high protein or blood content within the pseudocyst 2
• MRI would typically show heterogeneous hyperintensity on both T1 and T2-weighted sequences in hemorrhagic cysts 2
• Ultrasound might reveal heterogeneous hyperechoic and mobile material corresponding to clots 2

Clinical Implications

• Hemorrhagic pancreatic pseudocysts represent a potentially serious complication with mortality rates up to 40% if not properly managed 3
• The absence of active bleeding is an important distinction for both coding and clinical management 4, 5
• Intramural pseudocysts may have diverse clinical presentations ranging from asymptomatic to causing significant symptoms 1

Coding Considerations

• When coding this condition, it's important to note that the pseudocyst is:
  • Located in the gastric wall (intramural)
  • Involves the lesser curvature of the stomach
  • Shows evidence of previous hemorrhage (59 HU)
  • Currently without active bleeding 2, 1

Additional Relevant Codes

• Consider adding K31.89 (Other diseases of stomach and duodenum) as a secondary code to capture the gastric wall involvement 1
• If there is evidence of chronic pancreatitis as the underlying cause, K86.1 (Other chronic pancreatitis) may be appropriate as an additional code 3