ICD-10-CM: Don’t Give Up Too Soon When Coding Flank Pain

Mon, Feb 18, 2019 --

ICD-10, Skill Sharpener

Flank pain is a complaint a lot of general practices and specialties see. Here are some pointers on how to code correctly for this common condition.

Find Flank Under Abdominal in the Index

The flank is the side area of the torso below the ribs. To code for flank pain, start by looking at the ICD-10-CM index. Under the entry for “Pain, flank,” the ICD-10-CM index points you to “Pain, abdominal.” And that instruction opens up a lot of possibilities.

Next to the entry for “Pain, abdominal,” there is the code R10.9 (Unspecified abdominal pain). If “flank pain” is all you have to work with from the documentation, then R10.9 is the code to use. But if there is additional documentation that supports a more specific code under abdominal pain, you should choose that code instead. For instance, if further questioning helps the doctor determine the pain is in the upper right abdomen, you’ll use R10.11 (Right upper quadrant pain).

Consider this: It’s possible the examination will reveal that what the patient describes as “flank pain” is not in the abdomen, but is perhaps in the ribs or back. Be sure to code based on the documentation for the specific case.

Remember Signs and Symptoms Rules to Code Correctly

As a sign or symptom, pain is subject to the ICD-10-CM Official Guidelines for coding signs and symptoms. The general rule for physician coding is that you should use a code describing a symptom or sign “when a related definitive diagnosis has not been established (confirmed) by the provider,” the Official Guidelines state.

That means that if the physician determines the flank pain is related to a definitive diagnosis like a kidney stone (N20.-, Calculus of kidney and ureter), urinary tract infection (N39.0, Urinary tract infection, site not specified), or back strain (S39.012-, Strain of muscle, fascia and tendon of lower back), then you should code the specific definitive diagnosis instead of the pain.

Exception: Guidelines indicate that you may report a sign or symptom in addition to a related definitive diagnosis in cases where the sign or symptom isn’t routinely associated with the diagnosis.

Search the Official Guidelines for ‘Pain’ for Full Picture

If you use an electronic version of the ICD-10-CM Official Guidelines, you can use the find function to search the document for the word “pain.” Read through the various guidelines to increase your knowledge of coding for pain.

For instance: If the pain is exclusively related to a psychological disorder, the guidelines tell you to assign F45.21 (Hypochondriasis). The guidelines also discuss category G89.- (Pain, not elsewhere classified) to help you understand coding challenges like sequencing. And if you code for pain due to devices, implants, and grafts, or postoperative pain, the Official Guidelines have information for you, too.

What About You?

What’s your experience with reporting flank pain? If you code pain often, what’s one of the tips you’d share with someone just starting out?

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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