ICD 10 code for Abdominal Pain

The ICD 10 code for abdominal pain is a set of signs and symptom codes which can be coded only in the absence of a specific or definitive diagnosis.

 Coding “Abdominal pain ICD 10”, does it confuse you? 

Year end is round the corner and with festivals and celebrations lined up, one of the common symptoms that you will come across in the medical records will be “Abdominal pain”.

Does coding Abdominal pain ICD 10 confuse you? Understanding the documentation requirements and the code categories available in the ICD-10-CM manual will simplify the process.

Simply documenting “Abdominal pain” does not suffice the requirements for accurate coding. The location and the type also need to be specifically documented and to make things easier, it is also important that the terminologies used to document the location and type matches the descriptions in the ICD-10-CM manual.

For example if a physician orders a CT scan of the abdomen, the order should specifically mention if the CT scan is done for a generalized abdominal pain or pain in the right upper quadrant, right lower quadrant, left upper quadrant, left lower quadrant, epigastric or periumbilical regions. At the same time, the diagnosis supporting medical necessity should also specify the location and the type of the abdominal pain which is consistent with the order.

Always remember our goal is to avoid the unspecified codes and code the most specific code for the condition which will meet the medical necessity for any tests/procedures performed and the management of the condition.

Regions and Quadrants (Abdomen and Pelvis)

Abdominal pain can be caused by anyone of the following conditions-

AcuteChronicProgressive
·       Abdominal aortic aneurysm·      Angina·      Cancer
·       Appendicitis·      Celiac disease·      Crohn’s disease
·       Cholangitis·      Endometriosis·      Splenomegaly
·       Cholecystitis·      Gallstones·      Gallbladder cancer
·       Cystitis·      Gastritis·      Hepatitis
·       Diabetic ketoacidosis·      GERD·      Kidney cancer
·       Diverticulitis·      Hiatal hernia·      Liver cancer
·       Duodenitis·      Inguinal hernia·      Pancreatic cancer
·       Ectopic pregnancy·      Irritable bowel syndrome·      Stomach cancer
·       Fecal impaction·      Functional dyspepsia
·       Heart attack·      Ovarian cysts
·       Injury·      Pelvic inflammatory disease
·       Intestinal obstruction·      Peptic ulcer
·       Intussusception·      Sickle cell anemia
·       Kidney infection·      Ulcerative colitis
·       Kidney stones
·       Liver abscess
·       Mesenteric ischemia
·       Mesenteric lymphadenitis
·       Pancreatitis
·       Pericarditis
·       Peritonitis
·       Pleurisy
·       Pneumonia
·       Pulmonary infarction
·       Ruptured spleen
·       Salpingitis
·       Sclerosing mesenteritis
·       Shingles
·       Spleen infection
·       Splenic abscess
·       Colon injury
·   Urinary tract infection
·      Viral gastroenteritis

Organization of the abdominal pain codes in the ICD-10 manual

The abdominal pain codes belong to the category R10 (Abdominal and Pelvic pain)

The ICD 10 code for abdominal pain is arranged in the ICD-10 manual based on the severity of the pain. The list starts with the code R10.0 which represents the most severe or painful condition acute abdomen. The 4th digits 1,2 and 3 represents upper abdomen, pelvis and perineum and lower abdomen respectively and the digit 8 covers the other conditions- colic, generalized pain, tenderness, and rebound tenderness.

The definitions of the terms pertaining to abdominal pain and the related ICD 10 code for abdominal pain are below-

ICD 10 Code for Abdominal pain with descriptions:

 

 

 

ICD 10 code for abdominal pain – Examples:

  1. A 52-year-old female presents to the clinic with severe epigastric abdominal pain associated with nausea and vomiting. She rates the pain as 7-8/10 on the pain scale. She describes the pain as constant. The patient reports eating fried Turkey at her friend’s birthday party, 3 days ago.

The examination revealed abdominal distention and tenderness across the mid-upper abdomen with rigidity and diminished bowel sounds.

The patient was diagnosed with severe epigastric abdominal pain suspected of acute pancreatitis, epigastric abdominal tenderness and dehydration.

ICD-10-CM codes-

R10.13 – Epigastric abdominal pain ICD 10

R10.816 – Epigastric abdominal tenderness ICD 10

E86.0 – Dehydration ICD 10

Note: Acute pancreatitis is not coded as the condition is “suspected” and not confirmed.

  1. An 18-year-old male comes to the clinic with severe nausea and vomiting and pain in the right lower quadrant of his flank. He states that the pain began suddenly near the navel region and shifted to the lower right flank. He reports worsening of the pain when he coughs or walks. A CT scan of the flank was ordered. The ICD-10-CM codes on the order would be-

R10.31- Right lower quadrant abdominal pain ICD 10

Note: Flank pain is the same as abdominal pain as directed by the ICD-10-CM Index. So as per the guidelines, in the above example Flank pain ICD 10 coded with abdominal pain ICD 10 code.

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