2025 ICD-10-CM code R10.1
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Symptoms and signs involving the digestive system and abdomen - Pain localized to upper abdomen Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Feed
Pain localized to the upper abdomen.
Modifiers may be applicable depending on the context of the visit, but the specific circumstances must be documented for proper code selection and reimbursement.
Medical necessity for the use of R10.1 requires documentation of a thorough evaluation of upper abdominal pain.The evaluation must justify the uncertainty in determining the underlying etiology despite appropriate diagnostic workup. This is generally determined by medical review criteria of the specific payer, and may involve clinical judgment.
The clinical responsibility for this code involves a comprehensive assessment of the patient's abdominal pain, including a detailed history, physical examination, and appropriate investigations (such as imaging studies or laboratory tests) to determine the underlying cause.If the cause remains unclear despite these efforts, R10.1 is appropriately assigned. The physician must thoroughly document the evaluation process, including the diagnostic testing performed and negative findings.
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
- R10-R19 (Symptoms and signs involving the digestive system and abdomen)
In simple words: This code describes pain felt in the upper part of your stomach area.Doctors use it when they can't figure out exactly what's causing the pain after checking you.
This code is used to classify pain specifically located in the upper abdomen.It is applied when the pain's origin cannot be definitively determined through further investigation or when the cause is transient and undiagnosed.This code should only be used when more specific diagnoses are not available after a thorough examination.
Example 1: A 35-year-old female presents to the emergency department with acute onset of severe upper abdominal pain. Initial assessment and imaging (CT scan) were non-diagnostic; further investigations are planned.R10.1 is assigned as a temporary code., A 60-year-old male complains of intermittent, mild upper abdominal pain for several weeks.A thorough work-up including endoscopy revealed no significant findings. The patient's pain is attributed to functional dyspepsia, but R10.1 may be assigned if the etiology of the dyspepsia remains unclear., A 22-year-old patient presents with vague upper abdominal discomfort after a large meal.After a physical examination and review of patient history, the physician determines the cause is likely indigestion.However, if the patient returns for further evaluation but fails to return for follow-up, R10.1 might be used as a placeholder pending the results of the further investigation.
Detailed description of the pain (location, character, onset, duration, severity, aggravating and relieving factors).Complete documentation of the history, physical exam, and results of all diagnostic tests performed.A clear statement indicating the reason why a more specific diagnosis could not be assigned.
** This code is primarily used as a placeholder when the cause of upper abdominal pain is not immediately apparent or when a patient fails to return for follow-up after initial examination.It should be replaced with a more specific diagnosis when possible.Ensure thorough documentation to support this code's use.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Gastroenterology, General Surgery, Internal Medicine, Emergency Medicine
- Place of Service:Office, Emergency Room - Hospital, Inpatient Hospital, Outpatient Hospital, Urgent Care Facility