ICD-10 Coding for Substernal Chest Pain(R07.2)
Complete ICD-10-CM coding and documentation guide for Substernal Chest Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Substernal Chest Pain
Key Information: ICD-10 code for substernal chest pain
Essential facts and insights about Substernal Chest Pain
Primary ICD-10-CM Code for substernal chest pain
Decision Criteria
clinical Criteria
- Pain localized behind sternum with exertion
coding Criteria
- No confirmed cardiac diagnosis
documentation Criteria
- Explicit mention of 'substernal' in clinical notes
Applicable To
- Substernal chest pain
Excludes
- Angina pectoris (I20.-)
Clinical Validation Requirements
- Pain localized behind the sternum
- Worsens with exertion
- Radiates to left arm or jaw
Code-Specific Risks
- Misclassification if underlying cardiac condition is present
Coding Notes
- Ensure documentation specifies 'substernal' to avoid misclassification.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for other preprocedural examination
Z01.818Differential 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 Substernal Chest Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R07.2.
Impact
Clinical: Misleading clinical data, Regulatory: Potential audit issues, Financial: Incorrect reimbursement
Mitigation Strategy
Ensure documentation specifies 'substernal', Verify absence of specific cardiac diagnosis
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure provider documents any related injury explicitly before coding as such.
Impact
Lack of specificity in documentation may lead to audit flags.
Mitigation Strategy
Train staff on detailed documentation practices.
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 Substernal Chest Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Substernal Chest Pain
Use these documentation templates to ensure complete and accurate documentation for Substernal Chest Pain. These templates include all required elements for proper coding and billing.
Emergency Department Evaluation
Specialty: Emergency MedicineRequired Elements
- Pain onset and duration
- Pain quality and radiation
- Associated symptoms (e.g., diaphoresis, nausea)
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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