ICD-10 Coding for Epigastric Abdominal Pain(R10.13)
Complete ICD-10-CM coding and documentation guide for Epigastric Abdominal Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Epigastric Abdominal Pain
Key Information: ICD-10 code for epigastric abdominal pain
Essential facts and insights about Epigastric Abdominal Pain
Primary ICD-10-CM Code for epigastric abd pain
Decision Criteria
clinical Criteria
- Pain localized to the epigastric region with no confirmed diagnosis
coding Criteria
- Use R10.13 only when no definitive diagnosis is available
documentation Criteria
- Document location, character, duration, and associated symptoms
Clinical Validation Requirements
- Patient points to epigastrium
- Pain described as burning, cramping, or stabbing
- Duration and associated symptoms documented
Code-Specific Risks
- Confusion with heartburn or generalized abdominal pain
Coding Notes
- Ensure documentation specifies 'epigastric pain' and not vague terms like 'stomach ache'.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Epigastric Abdominal Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R10.13.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Train staff on specific documentation requirements.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use R12 if documentation states 'heartburn'.
Impact
Lack of specificity in documentation can lead to audit findings.
Mitigation Strategy
Ensure all required elements are documented clearly.
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 Epigastric Abdominal Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Epigastric Abdominal Pain
Use these documentation templates to ensure complete and accurate documentation for Epigastric Abdominal Pain. These templates include all required elements for proper coding and billing.
Initial encounter with undifferentiated pain
Specialty: GastroenterologyRequired Elements
- Location of pain
- Character of pain
- Duration
- Associated symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Epigastric Abdominal Pain? Ask your questions below.