Pain Management Coding Alert

Published on Fri Jan 06, 2017 PDF

Here’s why you must know the difference between generalized pain, tenderness.

Choosing the correct ICD-10 code for a patient with abdominal pain can make anyone queasy.

Although abdominal pain symptoms may seem quite simple to report, you need extensive documentation to pinpoint the reason for the complaint. Also, you need to know the pain’s exact location to get your coding correct.

Background:  Abdominal pain refers to any pain in the region between the chest and groin. The location, severity and extent of the pain are crucial aspects for a provider’s clinical decision making, as well as deciding on an appropriate code.

“ICD-10 coding is very specific,” says Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president, Healthcare Resource Management, Inc. Spring Lake, N.J. “Abdominal pain is found under chapter 18 of ICD-10, in category R10 (Abdominal and pelvic pain…). ICD-10 coding depends on the site, etiology and manifestation or state of the disease or condition.”

Best bet: “Communicate with your providers in order to get them to document appropriately,” advises Lisa Center, CPC, Physician Practice Manager at Via Christi Hospital Pittsburg, Inc. in Pittsburg, Kan.

Explore the range of codes available in the R10.-- (Abdominal and pelvic pain…), and use them judiciously to pinpoint the most appropriate code for the symptom. “When pain complaints are in more than one region then using more than one code may be appropriate,” says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel.

Code pain in upper abdomen with R10.1-: Within the R10.-- category, the subcategory R10.1- (Pain localized to upper abdomen) has codes that refer to pain arising from upper abdomen:

• R10.10 (Upper abdominal pain, unspecified)
• R10.11 (Right upper quadrant pain)
• R10.12 (Left upper quadrant pain)
• R10.13 (Epigastric pain) dyspepsia, excludes1 functional dyspepsia (K30.-).

Code pain in lower abdomen with R10.3-: Similarly, the subcategory R10.3- (Pain localized to other parts of lower abdomen) has codes that refer to pain arising from lower abdomen:

• R10.30 (Lower abdominal pain, unspecified)
• R10.31 (Right lower quadrant pain)
• R10.32 (Left lower quadrant pain)
• R10.33 (Periumbilical pain).

There is one other category (R10.8-, Other abdominal pain) where the fourth digit expands from one to four.

• R10.81- (Abdominal tenderness)
• R10.82 (Rebound abdominal tenderness)
• R10.83- (Colic)
• R10.84 (Generalized abdominal pain).

Codes R10.81 and R10.83 further expand into the sixth digits 0-7 and 9 to add more specificity and give more power to the physician to pinpoint the diagnosis. The expansions for both codes go as:

• 1 (Right upper quadrant)
• 2 (Left upper quadrant)
• 3 (Right lower quadrant)
• 4 (Left lower quadrant)
• 5 (Periumbilical)
• 6 (Epigastric)
• 7 (Generalized)
• 9 (Unspecified site).