ICD-10 Coding for Right Lower Abdominal Pain(R10.31, K35.2)
Complete ICD-10-CM coding and documentation guide for Right Lower Abdominal Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Lower Abdominal Pain
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R10.31 | Right lower quadrant pain | Use when the patient presents with pain localized to the right lower quadrant without a definitive diagnosis. |
|
| K35.2 | Acute appendicitis with localized peritonitis | Use when appendicitis is confirmed by imaging or surgery. |
|
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 right lower abdominal pain
Essential facts and insights about Right Lower Abdominal Pain
Primary ICD-10-CM Codes for right lower abd pain
Decision Criteria
clinical Criteria
- Presence of sharp, localized pain in the RLQ
documentation Criteria
- Documented rebound tenderness
Applicable To
- Localized pain in the right lower quadrant
Excludes
- Appendicitis (K35.-)
Clinical Validation Requirements
- Sharp, localized pain in RLQ
- Rebound tenderness
- Negative bowel sounds
Code-Specific Risks
- Using R10.9 instead of R10.31
- Lack of specificity in documentation
Coding Notes
- Ensure documentation specifies the quadrant and any associated symptoms like tenderness.
K35.2 - Acute appendicitis with localized peritonitis
Use when appendicitis is confirmed by imaging or surgery.
Applicable To
- Confirmed appendicitis with imaging
Excludes
- Unspecified appendicitis (K35.80)
Clinical Validation Requirements
- CT scan showing appendiceal dilation
- Elevated WBC count
Coding Notes
Do not use R10.31 if appendicitis is confirmed.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Right Lower Abdominal Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R10.31.
Impact
Clinical: May lead to misdiagnosis or delayed treatment, Regulatory: Increased risk of audit, Financial: Potential for lower reimbursement
Mitigation Strategy
Train staff on documentation standards, Use templates to ensure completeness
Impact
Reimbursement: Lower reimbursement due to non-specific coding, Compliance: Increased risk of audit due to lack of specificity, Data Quality: Decreased accuracy in patient records
Mitigation Strategy
Always specify the quadrant to use R10.31.
Impact
Audits may focus on whether the documentation supports the specificity of the code used.
Mitigation Strategy
Ensure detailed documentation of pain characteristics and location.
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 Right Lower Abdominal Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Lower Abdominal Pain
Use these documentation templates to ensure complete and accurate documentation for Right Lower Abdominal Pain. These templates include all required elements for proper coding and billing.
Suspected Appendicitis
Specialty: Emergency MedicineRequired Elements
- Location of pain
- Severity and quality
- Associated symptoms
- Physical exam findings
- Diagnostic test results
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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