2025 ICD-10-CM code R11.1
(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
Vomiting;This code is used to classify instances of vomiting where no more specific diagnosis can be made.
No modifiers are typically used with R11.1.
Medical necessity for R11.1 is established by the documentation of symptoms. When the provider cannot establish an underlying diagnosis despite conducting relevant investigations, the use of this code is considered medically necessary to represent the clinical picture. Note that this code might serve as a temporary or interim code, pending further diagnosis or workup.
The clinical responsibility for coding R11.1 lies with the physician or healthcare provider who assesses the patient and determines the appropriate diagnosis.The provider must document the clinical findings, investigations performed, and rationale for selecting this code over other, more specific diagnoses.If the cause of the vomiting is later identified, the code should be changed to reflect the definitive diagnosis.
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
- Symptoms and signs involving the digestive system and abdomen (R10-R19)
In simple words: This code means vomiting.Doctors use it when they can't figure out why someone is throwing up, even after doing tests.
This ICD-10-CM code, R11.1, signifies vomiting as a symptom. It's applied when a more precise diagnosis cannot be established, even after thorough investigation.This includes transient vomiting with undetermined causes, provisional diagnoses in patients who don't return for further care, cases referred elsewhere before diagnosis, situations lacking sufficient diagnostic information, and certain symptoms representing significant medical concerns.The code excludes cyclical vomiting associated with migraine, excessive vomiting during pregnancy, hematemesis, neonatal hematemesis, newborn vomiting, psychogenic vomiting, vomiting linked to bulimia nervosa, and vomiting following gastrointestinal surgery.
Example 1: A patient presents to the emergency room complaining of severe vomiting that began suddenly several hours ago.No other symptoms are present. After examination and basic testing, the cause of the vomiting is undetermined. R11.1 would be used., A patient is seen in a clinic for follow-up after undergoing abdominal surgery. The patient experiences occasional vomiting following the procedure, but no other significant symptoms are reported. The surgeon cannot pinpoint an underlying cause. R11.1 is appropriate., A pregnant woman experiences severe nausea and vomiting, but further investigation reveals that the symptoms are not consistent with hyperemesis gravidarum. No other specific cause is found,R11.1 would apply.
Detailed documentation is crucial for proper use of R11.1. The medical record should clearly state the patient's symptoms, the duration of the vomiting, any associated symptoms, investigations performed (such as blood tests, imaging studies, etc.), and the physician's reasoning for selecting this code. The absence of a more specific diagnosis must be clearly documented.
** R11.1 is a symptom code, and it should only be used as a placeholder until a definitive diagnosis is reached. Always ensure the documentation adequately supports the use of R11.1.If an underlying cause is later found, the code should be changed to reflect the correct diagnosis.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Gastroenterology, Internal Medicine, Family Medicine, Emergency Medicine, Obstetrics/Gynecology
- Place of Service:Office, Emergency Room - Hospital, Inpatient Hospital, Urgent Care Facility