Radiology Coding Alert

Documentation of quadrant will still be crucial in the new code system.Upper right side abdominal pain can make a physician suspect gallstones. But if the radiologist doesn't confirm a diagnosis, then you're left with coding the symptom: upper right abdominal pain. Read on to learn more about coding upper right abdominal discomfort.ICD-9-CM Codes789.01, Abdominal pain right upper quadrant789.61, Abdominal tenderness right upper quadrantICD-10-CM CodesR10.11, Pain localized to upper abdomen; right upper quadrant painR10.811, Right upper quadrant abdominal tendernessR10.821, Right upper quadrant rebound abdominal tendernessICD-9 coding rules: ICD-9 supplies one code for when the documented symptom is pain (789.01) and a second code for when the documented symptom is tenderness (789.61).ICD-10 changes: Pain code 789.01 corresponds directly to R10.11. However, ICD-10 offers two possible matches to tenderness code 789.61. The options are R10.811 (tenderness) and R10.821 (rebound tenderness). Documentation: To choose the most specific abdominal pain code, not only will you [...]