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2025 ICD-10-CM code R10.13

Epigastric pain; discomfort in the upper central abdomen.

Follow all official ICD-10-CM coding guidelines. Ensure the code accurately reflects the patient's symptoms and the lack of a definitive diagnosis. R10.13 should only be used when the pain is clearly localized to the epigastric region, and other possible diagnoses are ruled out through the appropriate diagnostic process. If a specific diagnosis is determined, use that code instead.

Not applicable to ICD-10 codes.

Medical necessity for coding R10.13 is established when the patient presents with epigastric pain, and after a thorough clinical evaluation, no definitive diagnosis can be made. The medical necessity is further substantiated by the documentation of a detailed history, physical examination findings, and any ordered investigations to rule out more serious conditions.

The clinical responsibility for a patient presenting with epigastric pain would include a thorough history and physical examination focusing on the gastrointestinal system.Investigations may include blood work, imaging studies (ultrasound, CT scan), and potentially endoscopy to rule out underlying pathologies. The physician should document the patient's symptoms, their characteristics (location, duration, severity, radiation), aggravating and relieving factors, and associated symptoms.A differential diagnosis should be established, and the medical necessity of any further investigations must be well documented.

IMPORTANT:If a specific cause for the epigastric pain is identified, the code for that specific condition should be used instead of R10.13. For example, if the pain is due to a peptic ulcer, the appropriate K25 code would be used.Other codes such as R10.10 (Upper abdominal pain, unspecified), R10.11 (Right upper quadrant pain), R10.12 (Left upper quadrant pain) might be considered depending on the precise location of the pain.The use of R10.13 should be reserved for cases where the pain is clearly localized to the epigastric region and no specific diagnosis can be made.

In simple words: This code means the patient has pain in the upper middle part of their stomach.The doctor doesn't know the exact reason for the pain yet.

R10.13, Epigastric pain, is an ICD-10-CM code that classifies pain specifically localized to the epigastrium, the upper central region of the abdomen.This code is used when the pain is the primary reason for the encounter and a more definitive diagnosis cannot be established. It is crucial to note that this code should not be used if a specific cause for the epigastric pain is identified (e.g., appendicitis, peptic ulcer).Additional documentation is necessary to support the medical necessity of the visit and to clarify the nature of the pain (e.g., sharp, burning, cramping). Excludes: Functional dyspepsia (K30), renal colic (N23).

Example 1: A 45-year-old male presents to the emergency department complaining of severe, burning epigastric pain for the past 2 hours.He denies nausea, vomiting, or fever.The physician performs a physical exam, and initial labs are unremarkable.A diagnosis of R10.13 is assigned pending further investigation. An upper endoscopy is scheduled., A 60-year-old female presents to her primary care physician complaining of intermittent epigastric discomfort for several weeks. The pain is described as dull and aching. She reports occasional heartburn. Physical exam and initial lab work are unremarkable.The physician orders further tests and assigns a diagnosis of R10.13., A 28-year-old presents to their physician complaining of epigastric pain and reports excessive alcohol consumption. Physical exam is unremarkable; labs show elevated liver enzymes.R10.13 is coded in conjunction with a more specific code reflecting liver issues pending further investigation.

** When documenting epigastric pain, ensure the location is precisely defined.Differentiate between epigastric, right upper quadrant, left upper quadrant, or other abdominal pain locations for optimal coding specificity.Document the severity, character, and duration of the pain; associated symptoms; and any relevant patient history.

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