ICD-10 Coding for Sternum Pain(M94.0, R07.89, S22.20XA)
Complete ICD-10-CM coding and documentation guide for Sternum Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sternum Pain
M94.0Primary Range
Chondrocostal junction syndrome [Tietze]
Primary code for costochondritis, a common cause of sternum 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 |
|---|---|---|---|
| M94.0 | Chondrocostal junction syndrome [Tietze] | Use when costochondritis is confirmed by clinical examination. |
|
| R07.89 | Other chest pain | Use when sternum pain is present but not specifically diagnosed as costochondritis. |
|
| S22.20XA | Fracture of sternum, initial encounter | Use for initial encounter of traumatic sternum pain due to fracture. |
|
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 sternum pain
Essential facts and insights about Sternum Pain
Primary ICD-10-CM Codes for sternum pain
Decision Criteria
clinical Criteria
- Tenderness at costosternal junction without swelling
Applicable To
- Costochondritis
Excludes
- Tietze's syndrome with swelling
Clinical Validation Requirements
- Tenderness on palpation at costosternal junction
- No swelling present
- Negative cardiac biomarkers
Code-Specific Risks
- Incorrectly using for Tietze's syndrome if swelling is present.
Coding Notes
- Ensure documentation specifies absence of swelling to differentiate from Tietze's syndrome.
R07.89 - Other chest pain
Use when sternum pain is present but not specifically diagnosed as costochondritis.
Applicable To
- Localized sternum pain
Excludes
- Costochondritis (M94.0)
Clinical Validation Requirements
- Pain localized to sternum
- No specific diagnosis like costochondritis
Coding Notes
Ensure pain is documented as localized to sternum without a specific diagnosis.
S22.20XA - Fracture of sternum, initial encounter
Use for initial encounter of traumatic sternum pain due to fracture.
Applicable To
- Traumatic sternum pain
Clinical Validation Requirements
- Confirmed fracture via imaging
Coding Notes
Ensure fracture is confirmed by imaging before coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Acute pain due to trauma
G89.11Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sternum Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M94.0.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Increases risk of audit issues., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Ensure detailed documentation of pain characteristics., Use specific codes when possible.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces specificity in clinical data.
Mitigation Strategy
Use M94.0 for confirmed costochondritis or R07.89 for localized sternum pain.
Impact
Using R07.9 when a more specific code is applicable.
Mitigation Strategy
Ensure thorough documentation to support specific coding.
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 Sternum Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sternum Pain
Use these documentation templates to ensure complete and accurate documentation for Sternum Pain. These templates include all required elements for proper coding and billing.
Sternum pain with suspected costochondritis
Specialty: Primary CareRequired Elements
- Pain location and characteristics
- Palpation findings
- Associated symptoms
- Exclusion of cardiac causes
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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