ICD-10 Coding for Right Lower Quadrant Pain(R10.31, K35.2)
Complete ICD-10-CM coding and documentation guide for Right Lower Quadrant Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Lower Quadrant Pain
R10.0-R10.9Primary Range
Abdominal and pelvic pain
This range includes codes for various types of abdominal pain, including right lower quadrant pain.
Diseases of appendix
This range includes codes for appendicitis, which is a common cause of right lower quadrant 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 |
|---|---|---|---|
| R10.31 | Right lower quadrant pain | Use when the patient presents with pain localized to the right lower quadrant and no definitive diagnosis is made. |
|
| K35.2 | Acute appendicitis with generalized peritonitis | Use when appendicitis with peritonitis is confirmed. |
|
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 right lower quadrant pain
Essential facts and insights about Right Lower Quadrant Pain
Primary ICD-10-CM Codes for right lower quadrant
Decision Criteria
clinical Criteria
- Pain localized to the right lower quadrant without a confirmed diagnosis
Applicable To
- Pain localized to the right lower quadrant
Excludes
- Pain due to appendicitis (K35.-)
Clinical Validation Requirements
- Physical exam showing tenderness in the right lower quadrant
- Patient reports pain localized to the right lower quadrant
Code-Specific Risks
- Risk of undercoding if a more specific diagnosis is confirmed later
Coding Notes
- Ensure documentation specifies the location and nature of the pain.
K35.2 - Acute appendicitis with generalized peritonitis
Use when appendicitis with peritonitis is confirmed.
Applicable To
- Appendicitis with peritonitis
Excludes
- Chronic appendicitis (K36)
Clinical Validation Requirements
- CT scan showing inflamed appendix
- Elevated white blood cell count
Coding Notes
Ensure appendicitis is confirmed through imaging or surgical findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Right lower quadrant rebound tenderness
R10.813Differential 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 Right Lower Quadrant Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R10.31.
Impact
Clinical: May lead to misdiagnosis or delayed treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Train staff on detailed documentation practices, Use templates to ensure comprehensive notes
Impact
Reimbursement: Incorrect DRG assignment can affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use K35.2 as the principal diagnosis if appendicitis is confirmed.
Impact
Risk of using symptom codes as primary when a definitive diagnosis is available.
Mitigation Strategy
Ensure thorough review of clinical documentation and confirm diagnosis before 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 Right Lower Quadrant Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Lower Quadrant Pain
Use these documentation templates to ensure complete and accurate documentation for Right Lower Quadrant Pain. These templates include all required elements for proper coding and billing.
Emergency Department Visit for RLQ Pain
Specialty: Emergency MedicineRequired Elements
- Onset and duration of pain
- Location and character of pain
- Associated symptoms (e.g., nausea, vomiting)
- Physical exam findings
- Imaging and lab results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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