Coding for abdominal pain should not give you a stomach ache

November 9th, 2018 / By Kelly Long, CPC

I have encountered many physician practices and facilities in my role as coding analyst that are often stumped on the actual language needed to support specific ICD-10 codes for abdominal pain. They wonder why the coders choose R10.9 (unspecified abdominal pain) rather than a more specific ICD-10 code. It all comes down to documentation: If the provider states that abdominal pain is the only reason for the exam, then yes, R10.9 is the appropriate code to choose. When documenting a diagnosis of abdominal pain, it is important to not only identify the pain location but also the pain type. The following should always be included: Location e.g. generalized, right upper quadrant, periumbilical, etc.; pain or tenderness type e.g. colic, tenderness, rebound.

For example, when a physician orders an MRI of the abdomen, the order template should prompt them to document whether the MRI is performed for abdominal pain in the right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant, or whether it is epigastric, periumbilical or generalized.

If this detailed information is NOT available to the coder, query the ordering physician. Coders should not try to determine a more specific code if the provider has not documented that specific diagnosis.

ICD-10-CM contains over 30 different codes in category R10 for various types of abdominal and pelvic pain:

ABDOMINAL AND PELVIC PAIN CODES

Of the multiple ICD-10 codes for abdominal pain that exist, there are some key factors to keep in mind.

Severity of the condition

The R10 ICD-10 codes are listed by severity of pain, with the most painful condition, R10.0 (Acute abdomen) appearing first, followed by the more general terms of pain R10.12 (example, left upper quadrant abdominal pain) with the lowest levels on the intensity scale, tenderness and rebound tenderness, R10.8 (Other abdominal pain) codes following.

Location of pain

The fourth digits in the R10 ICD-10 codes (Abdominal and pelvic pain) pinpoint the location of pain. They move from the upper to the lower parts of the abdominal region:

  • 1 = upper abdomen
  • 2 = pelvis and perineum
  • 3 = lower abdomen
  • 8 = other

Both the upper and lower abdominal codes are further divided into right and left quadrants (designated by fifth digits 1, for the right side, and 2 for the left) to add further specificity. And both code groups also include a specific code that pinpoints location by anatomical region rather than quadrant, such as R10.13 (Epigastric pain).

Signs and Symptoms Codes

As a final reminder, ICD-10 R10 are a signs and symptoms set of codes; if the provider makes a definitive diagnosis like appendicitis (K35-K37), then the more definitive diagnosis should be coded instead and not the abdominal pain code.

I hope the above recommendations make R10 ICD-10 coding a little easier. After all, with Thanksgiving coming up I have no doubt you will be encountering plenty of patients with stomach pain after enjoying their feasts with loved ones.

Kelly Long is a clinical development analyst with 3M Health Information Systems.