2025 ICD-10-CM code R10.9
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Symptoms - Symptoms and signs involving the digestive system and abdomen Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Feed
Unspecified abdominal pain.
Not applicable for ICD-10-CM codes.
Medical necessity for assigning R10.9 is established when a patient presents with abdominal pain and, after appropriate evaluation, the cause cannot be determined.This requires appropriate documentation of the examination, findings, and efforts to determine the cause.
The clinical responsibility for coding R10.9 involves a complete history and physical examination, thorough investigation to rule out other causes, and documentation of all relevant findings.If the pain persists or worsens, further investigation might include imaging studies, laboratory tests, or consultations with specialists.
- 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 is used when someone has pain in their stomach area, but doctors can't figure out exactly what's causing it, even after checking.
This code represents unspecified abdominal pain, meaning pain in the abdomen that cannot be attributed to a more specific cause or location after a thorough investigation.It encompasses situations where the cause remains undetermined even after all relevant information has been gathered. This might include transient pain, cases with incomplete investigations, or referrals for further testing where a diagnosis isn't established before transfer of care.
Example 1: A patient presents to the emergency department with diffuse abdominal pain of unknown origin.After a thorough evaluation, no specific diagnosis can be established. R10.9 is used., A patient reports vague abdominal discomfort that resolves spontaneously within a few hours.After a brief examination, no identifiable cause is found, and R10.9 is assigned. The patient does not return for follow up., A patient is referred to a gastroenterologist for persistent abdominal pain.Initial testing is inconclusive.The referring physician uses R10.9 until the specialist provides a specific diagnosis.
Detailed history of the onset, location, character, duration, and severity of the abdominal pain.Documentation of any associated symptoms (e.g., nausea, vomiting, diarrhea, fever, etc.).Results of any investigations performed (e.g., physical examination, laboratory tests, imaging studies).Physician's assessment of the pain and reason for assigning the code.If the pain is transient, this should be noted.
** This code should be used cautiously and only when appropriate.It is crucial to ensure thorough documentation to support the assignment of R10.9, as an overly broad application of this code might lead to inaccurate reporting.
- Revenue Code: Revenue codes will vary depending on the healthcare setting and the services provided. Consult your local coding guidelines.
- RVU: RVUs are not directly associated with ICD-10 codes. RVUs are assigned to CPT and HCPCS codes and used for reimbursement calculations based on procedure complexity and resource costs.
- Global Days: Not applicable; this is a diagnostic code, not a procedural code.
- Payment Status: Active
- Modifier TC rule: Not applicable for ICD-10-CM codes.
- Fee Schedule: Not applicable; ICD-10 codes are not associated with fee schedules.
- Specialties:Multiple specialties may use this code, particularly gastroenterology, internal medicine, emergency medicine, and general surgery.
- Place of Service:This code can be used across various settings including hospitals (inpatient and outpatient), clinics, physician offices, and emergency departments.