Here’s Where to Turn When Coding for Chest Pain

Thu, Oct 24, 2019 --

ICD-10, Skill Sharpener

ICD-10-CM coding for chest pain

A lot of primary care physicians and specialists see patients presenting with chest pain. In many cases, the provider may not be able to confirm a more specific diagnosis for the encounter. To ensure you’re coding this symptom correctly, follow these pointers on ICD-10-CM coding for chest pain.

Use Both the Index and Tabular List for Accurate Coding

When you look up the entry for “pain/chest” in the ICD-10-CM Alphabetic Index, here’s what you’ll discover:

  • The default code for chest pain is R07.9 (Chest pain, unspecified), according to the index. If the documentation provides you with additional information, check to see whether another code would be appropriate instead of this “unspecified” code. Using the most specific code is correct coding and also may better support services you submit on the claim.
  • If the chest pain is documented with the terms anterior wall (or wall), atypical, musculoskeletal, or non-cardiac, then you should look at R07.89 (Other chest pain).
  • For ischemic pain, you should leave category R07.- (Pain in throat and chest) and consider I20.9 (Angina pectoris, unspecified).
  • For chest pain on breathing, report R07.1 (Chest pain on breathing). The ICD-10-CM Tabular List adds that this code applies to painful respiration.
  • The index entry for “pleurodynia” points to R07.81 (Pleurodynia). The definition for the medical term pleurodynia is pain in the pleural cavity, the (potential) space between the membranes known as the parietal and visceral pleurae. The parietal pleura lines the walls of the thoracic cavity. The visceral pleura covers the lungs. Don’t miss that the Tabular List has an Excludes1 note at R07.81 directing you to B33.0 (Epidemic myalgia) for epidemic pleurodynia, an acute infectious condition caused by viruses.
  • The index entry for “precordial” pain points to R07.2 (Precordial pain). The precordial region is on the front of the body, covering the heart and part of the upper-middle abdomen.

Remember: If you start your code search in the ICD-10-CM Alphabetic Index, confirm your code choice in the Tabular List before you make your final code assignment. You may discover there’s a more appropriate code for your case, or you may see an important note that affects your coding.

Look Beyond the Individual Code’s Notes in the Tabular List

In the previous section, you saw some code-level notes that affect coding for chest pain. But, as with all ICD-10-CM coding, you need to check for notes at other levels (subcategory, category, block, chapter) that apply to your code.

Example: Throat and chest pain category R07.- has these notes:

  • Excludes1: epidemic myalgia (B33.0)
  • Excludes2: jaw pain (R68.84), pain in breast (N64.4).

Those notes apply to all codes that begin with R07.

Review the Official Guidelines on Coding Pain

Everyone who reports ICD-10-CM codes can benefit from reading the ICD-10-CM Official Guidelines for Coding and Reporting. They are updated every year and are effective on Oct. 1, just as ICD-10-CM codes are. For chest pain coding, here are two pointers from the Official Guidelines to keep in mind.

Coding symptoms: “Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider,” the Official Guidelines state at Section I.B.4.

For chest pain, that means using one of the R07.- codes is appropriate when the provider has not documented a confirmed diagnosis that chest pain is routinely associated with.

Read the guidelines in Section I.C.18 for more about proper use of codes from Chapter 18, which includes codes for signs and symptoms.

Coding postoperative pain: If a patient complains about chest pain after a medical procedure, check Official Guidelines Section I.C.6.b about proper use of G89.- (Pain, not elsewhere classified). You’ll get authoritative guidance on proper coding for post-thoracotomy and other postoperative pain.

There are plenty of other helpful hints in this section, too, so if you code for pain (and chances are you do!), be sure to read this part of the Official Guidelines.

What About You?

What are your tips for accurate ICD-10-CM coding of chest pain?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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