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The coding for this scenario would be as follows: Primary code: K26.2 (because the type of ulcer is duodenal and it is acute with hemorrhage and perforation) Secondary code: F10.231 (because she exhibits alcohol dependence with withdrawal delirium) Tertiary code: Y90.3 (because of the range of her blood alcohol level is 60-79 mg/100 ml) This is how you think in an ICD-10 world

The most common locations for an oral melanotic macule include vermillion border of the lips, buccal mucosa, and palate

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In addition to the pathology, the gross appearance of the lesion suggested that it was too malignant to be a simple schwannoma or ependymoma, and the lack of cutaneous lesions suspicious for melanoma further supported the diagnosis