ICD-10 Coding for Epigastric Discomfort(R10.13, K21.9)
Complete ICD-10-CM coding and documentation guide for Epigastric Discomfort. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Epigastric Discomfort
R10-R19Primary Range
Symptoms and signs involving the digestive system and abdomen
This range includes codes for various abdominal symptoms, including epigastric pain.
Diseases of esophagus, stomach, and duodenum
This range includes specific conditions like GERD and gastritis that may cause epigastric discomfort.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R10.13 | Epigastric pain | Use when the patient presents with epigastric pain and no underlying cause has been confirmed. |
|
| K21.9 | Gastro-esophageal reflux disease without esophagitis | Use when GERD is diagnosed and is the cause of epigastric discomfort. |
|
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 epigastric discomfort
Essential facts and insights about Epigastric Discomfort
Primary ICD-10-CM Codes for epigastric discomfort
Decision Criteria
clinical Criteria
- Pain is localized to the epigastric region and no other cause is confirmed.
coding Criteria
- Do not use if a specific diagnosis like gastritis or pancreatitis is confirmed.
Applicable To
- Pain localized to the epigastric region
Clinical Validation Requirements
- Patient reports pain localized to the epigastric region
- No definitive diagnosis established
Code-Specific Risks
- Using R10.13 when a definitive diagnosis is known can lead to incorrect coding.
Coding Notes
- Ensure that the documentation specifies the location and nature of the pain.
K21.9 - Gastro-esophageal reflux disease without esophagitis
Use when GERD is diagnosed and is the cause of epigastric discomfort.
Applicable To
- GERD without esophagitis
Excludes
- GERD with esophagitis (K21.0)
Clinical Validation Requirements
- Endoscopy or pH monitoring confirms GERD without esophagitis
Coding Notes
Document the diagnostic method used to confirm GERD.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Gastro-esophageal reflux disease without esophagitis
K21.9Differential 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 Epigastric Discomfort 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 coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always specify the exact location of pain., Use detailed descriptors.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: May result in non-compliance with coding guidelines., Data Quality: Affects the accuracy of patient records.
Mitigation Strategy
Use the specific diagnosis code as primary and R10.13 only if pain is still relevant.
Impact
Using symptom codes as primary when a definitive diagnosis exists.
Mitigation Strategy
Educate coders on proper sequencing rules.
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 Discomfort, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Epigastric Discomfort
Use these documentation templates to ensure complete and accurate documentation for Epigastric Discomfort. These templates include all required elements for proper coding and billing.
Suspected Peptic Ulcer
Specialty: GastroenterologyRequired Elements
- Pain description
- Diagnostic tests
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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