ICD-10 Coding for Groin Pain(R10.813, S76.811A)
Complete ICD-10-CM coding and documentation guide for Groin Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Groin Pain
R10.8Primary Range
Other abdominal pain
Includes specific codes for localized abdominal pain relevant to groin pain.
Strain of muscle and tendon at hip and thigh level
Includes codes for muscle strains that can cause groin pain.
Pain, not elsewhere classified
Used for pain management coding when pain is the primary focus of care.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R10.813 | Right lower quadrant abdominal pain | Use when pain is specifically localized to the right lower quadrant without a definitive diagnosis. |
|
| S76.811A | Strain of right adductor muscle, initial encounter | Use when a strain of the right adductor muscle is confirmed. |
|
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 groin pain
Essential facts and insights about Groin Pain
Primary ICD-10-CM Codes for groin pain
Decision Criteria
clinical Criteria
- Pain localized to the right lower quadrant with tenderness
Applicable To
- Pain localized to the right inguinal region
Excludes
- Generalized abdominal pain (R10.84)
Clinical Validation Requirements
- Physical exam showing tenderness in the right inguinal canal
- Pain exacerbated by coughing or Valsalva maneuver
Code-Specific Risks
- Misclassification as generalized pain
Coding Notes
- Ensure documentation specifies the exact location and nature of the pain.
S76.811A - Strain of right adductor muscle, initial encounter
Use when a strain of the right adductor muscle is confirmed.
Applicable To
- Adductor muscle strain during physical activity
Excludes
- Chronic strain (S76.811D)
Clinical Validation Requirements
- MRI showing adductor muscle edema or tear
- Pain with resisted hip adduction
Coding Notes
Document the mechanism of injury and confirm with imaging if possible.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Acute pain due to trauma
G89.11Differential 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 Groin Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R10.813.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with coding updates., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Regularly review and update codes as diagnoses are confirmed., Educate staff on the importance of accurate coding.
Impact
Reimbursement: May lead to claim denials due to lack of specificity., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data affecting patient records and statistics.
Mitigation Strategy
Ensure documentation specifies the quadrant or specific region of pain.
Impact
Audits may target records with non-specific pain codes.
Mitigation Strategy
Ensure documentation specifies the exact location and nature of the pain.
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 Groin Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Groin Pain
Use these documentation templates to ensure complete and accurate documentation for Groin Pain. These templates include all required elements for proper coding and billing.
Sports Medicine Progress Note
Specialty: Sports MedicineRequired Elements
- Subjective pain description
- Objective findings including tenderness and imaging results
- Assessment with specific ICD-10 code
- Plan for treatment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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