ICD-10 Coding for Thorax Pain(M54.6, R07.1, M94.0)
Complete ICD-10-CM coding and documentation guide for Thorax Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Thorax Pain
M54-M54.9Primary Range
Dorsalgia, including thoracic spine pain
This range includes codes for pain in the thoracic region, specifically musculoskeletal in nature.
Chest pain, unspecified
This range covers various types of chest pain, including those related to respiratory issues.
Chondrocostal junction syndrome [Tietze]
This code is used for costochondritis, a specific type of musculoskeletal chest 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 |
|---|---|---|---|
| M54.6 | Pain in thoracic spine | Use when pain is localized to the thoracic spine without underlying disc disease. |
|
| R07.1 | Chest pain on breathing | Use when chest pain is specifically linked to breathing. |
|
| M94.0 | Chondrocostal junction syndrome [Tietze] | Use for costochondritis with sternal tenderness. |
|
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 thorax pain
Essential facts and insights about Thorax Pain
Primary ICD-10-CM Codes for thorax pain
Decision Criteria
clinical Criteria
- Pain localized to thoracic spine with normal imaging
coding Criteria
- Excludes disc disorders
R07.1 - Chest pain on breathing
Use when chest pain is specifically linked to breathing.
Applicable To
- Pain worsens with deep breathing
Excludes
- Thoracic spine pain (M54.6)
Clinical Validation Requirements
- Pain linked to respiratory movements
Coding Notes
Ensure respiratory link is documented.
M94.0 - Chondrocostal junction syndrome [Tietze]
Use for costochondritis with sternal tenderness.
Applicable To
- Costochondritis
Excludes
- Other chest pain (R07.-)
Clinical Validation Requirements
- Reproducible sternal tenderness
Coding Notes
Document sternal tenderness clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic pain syndrome
G89.21Differential 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 Thorax Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.6.
Impact
Clinical: Misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Use detailed templates for documentation, Regular training on documentation standards
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation specifies thoracic spine involvement.
Impact
Risk of audits due to improper coding of thoracic pain as general chest pain.
Mitigation Strategy
Ensure thorough documentation and correct code selection.
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 Thorax Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Thorax Pain
Use these documentation templates to ensure complete and accurate documentation for Thorax Pain. These templates include all required elements for proper coding and billing.
Musculoskeletal Thorax Pain
Specialty: OrthopedicsRequired Elements
- Location
- Quality
- Severity
- Timing
- Provocation
- Associated symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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