ICD-10 Coding for Epigastric Pain(R10.13, K21.9)
Complete ICD-10-CM coding and documentation guide for Epigastric Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Epigastric Pain
R10-R19Primary Range
Symptoms and signs involving the digestive system and abdomen
This range includes symptom codes for abdominal pain, including epigastric pain.
Diseases of esophagus, stomach and duodenum
This range includes definitive diagnoses that may present with epigastric pain, such as gastritis and GERD.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R10.13 | Epigastric pain | Use when epigastric pain is the primary symptom and no definitive diagnosis is established. |
|
| K21.9 | Gastro-esophageal reflux disease without esophagitis | Use when GERD is confirmed and documented. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for epigastric pain
Essential facts and insights about Epigastric Pain
Primary ICD-10-CM Codes for epigastric pain
Decision Criteria
clinical Criteria
- Pain localized to the epigastric region without specific diagnostic findings.
coding Criteria
- No definitive diagnosis established; symptom coding is appropriate.
documentation Criteria
- Detailed description of pain characteristics and associated symptoms.
Applicable To
- Localized epigastric pain
Excludes
- Acute abdomen (R10.0)
Clinical Validation Requirements
- Localized pain in the epigastric region without a confirmed diagnosis
- Absence of findings indicative of a specific condition such as GERD or gastritis
Code-Specific Risks
- Risk of undercoding if a definitive diagnosis is available but not documented.
Coding Notes
- Ensure documentation specifies the epigastric location and excludes other specific diagnoses.
K21.9 - Gastro-esophageal reflux disease without esophagitis
Use when GERD is confirmed and documented.
Applicable To
- GERD without esophagitis
Excludes
- Esophagitis (K20.9)
Clinical Validation Requirements
- Endoscopic evidence of GERD
- pH monitoring results indicating reflux
Coding Notes
Ensure GERD is confirmed through appropriate diagnostic tests.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified abdominal pain
R10.9Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Epigastric Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R10.13.
Impact
Clinical: May lead to incorrect diagnosis and treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Always specify the location of abdominal pain., Use detailed descriptors for pain characteristics.
Impact
Reimbursement: May lead to down-coding and reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use the specific diagnosis code, such as K21.9 for GERD.
Impact
Using symptom codes when a definitive diagnosis is available.
Mitigation Strategy
Ensure thorough documentation and use of definitive diagnosis codes when confirmed.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Epigastric Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Epigastric Pain
Use these documentation templates to ensure complete and accurate documentation for Epigastric Pain. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Epigastric Pain
Specialty: Emergency MedicineRequired Elements
- Pain location and characteristics
- Associated symptoms
- Duration and onset
- Aggravating and relieving factors
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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