Abdominal Pain ICD-10 – Diagnosing and Coding Guidelines

August 30, 2021

icd 10 code for abdominal pain

Abdominal pain is fairly common and most people experience it at some point in their lives. Also known as bellyache or stomachache, abdominal pain is usually felt in the area just below the ribs and above the groin and pelvis, and can range from a mild ache to more severe, disabling pain.

Even though abdominal pain is not life-threatening, there are certain forms that may indicate a serious underlying health condition causing the pain. It is important, therefore, to seek proper medical conditions if you experience abdominal pain and let your healthcare physician identify the cause and give proper treatment.

When documenting a diagnosis of abdominal pain by physicians, it is important to not only identify the pain location but also the pain type. Oftentimes, medical coders and physicians are stumped when coding for abdominal pain ICD 10. Identifying the location, as well as the pain type or tenderness is imperative for accurately coding and documenting cases for abdominal pains.

What is Abdominal Pain?

The abdomen is the area bounded by the diaphragm and lower ribs, falling above the pelvic bone. While abdominal pain can be caused by the inflammation of the tissues found in the abdominal wall, the pain typically originates due to discomfort caused by the organs in the abdominal cavity. These organs include the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas.

Causes of Abdominal Pain

There are various conditions that can lead to abdominal pain including obstruction, inflammation, intestinal disorders, and various infections. Infections are caused when bacteria enter your digestive tract via the intestines, blood, or the throat resulting in mild to severe pains, diarrhea, and constipation.

Another common cause of abdominal pain in women is cramps associated with menstruation which can lead to pain in the abdomen and the pelvis. Other major causes of abdominal pains are:

  • Stress
  • Constipation
  • Diarrhea
  • Stomach flu
  • GERD (acid reflux)
  • Organ rupture such as appendix
  • Stones in the gallbladder or kidneys
  • Kidney infection

Symptoms

Depending on the location of the pain and the severity, abdominal pain is categorized into different forms. Generalized abdominal pain is felt in most of your abdomen, caused by gas, indigestion, or stomach viruses. Localized abdominal pain is found in a specific area of the abdomen and is typically caused by a problem with one of the organs in the abdominal cavity.

Cramping is another type of abdominal pain that comes and goes and is attributed to passing stool, menstruation, or gas as the culprit causing the pain. Similarly, colic is another type that comes and goes, but is more severe than cramping and is usually caused by gallstones or kidney stones.

If you are experiencing abdominal pain accompanied by any of the following symptoms, seek immediate medical attention:

  • Abdomen very tender to touch
  • Bloody stool
  • Fever
  • Swollen abdomen
  • Nausea and vomiting
  • Yellowish skin

ICD 10 Code Set

ICD-10 (short for International Classification of Diseases, tenth edition) is a clinical documentation and cataloging system owned by the World Health organization which consists of thousands of codes, where each code represents critical information about the different diseases, findings, causes of injuries, symptoms, possible treatments, and epidemiology, playing a vital role in enabling advancements in clinical treatment and medication.

Under the Health Insurance Portability and Accountability Act (HIPAA), it is required by all healthcare providers and physicians to apply the ICD-10 codes in their practices, replacing the previous ICD-9 code set.

ICD serves as a foundation to identify clinical trends and statistics globally. Diseases, injuries, disorders, and all health conditions are listed comprehensively and organized into standard groupings allowing health care providers from around the world to compare and share information using the ICD codes.

Abdominal Pain ICD-10 Codes

There are over 30 different codes falling under the R10 category of the ICD-10-CM manual, corresponding to the different types of abdominal pains including:

From the table, it is important to take note of a couple of points. First, the codes are listed by the severity of pain, with the more severe conditions appearing on top.

The right lower quadrant and left lower quadrant are grouped under lower abdominal pain ICD-10 while the right upper and left upper quadrant is mapped to the upper abdominal pain.

Coding Guidelines for Abdominal Pain

The above codes describe the symptoms for abdominal pain and not the specific diagnoses, due to which they are normally assigned to cases when conclusive diagnoses have not been made yet. These codes may also be used when the abdominal pain symptom occurs alongside a diagnosis that is not typically associated with it, but the code for the main diagnosis should always be recorded first.

To ensure accuracy when recording the codes, it is important to record the highest number of characters based on the information provided. Where a patient’s data is not sufficient to assign a specific code, coders do have the option to assign from the unspecified abdominal pain ICD-10 codes.

Lastly, if the patient is experiencing abdominal pain in multiple places, the best practice is to use a separate code for each location.

The fourth digits in the abdominal pain ICD-10 codes pinpoint the location of the pain. They move from the upper to the lower parts of the abdominal region:

1 = upper abdomen

2 = pelvis and perineum

3 = lower abdomen

8 = other

Conclusion

When documenting a diagnosis of abdominal pain, it is important to not only identify the pain location but also the pain type. The following should always be included: Location e.g. generalized, right upper quadrant, periumbilical, etc.; pain or tenderness type e.g. colic, tenderness, rebound.

In case the information/data is not enough for the coder, confirm from the relevant physician and avoid assigning a specific code if the diagnosis is not documented by the physician.

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