ICD-10 Codes for Chest Pain

Are you confused about which ICD 10 codes to apply for your patient’s cases of chest pain? RO7 is the one code that you must always be mindful of. It is the primary code for chest pain and, as such, it is non-billable. This blog explains all the codes associated with chest pain.

We also discuss the coding guidelines that you can follow for assigning them. There are three scenarios outlined for you as well that highlight how to appropriately assign ICD 10 codes. 

Also, improve your revenue cycle with our reliable coding service. We specialize in aligning with ICD-10 standards for optimized billing. See how we enhance your practice.

List of ICD-10 Codes for Chest Pain

The primary code for chest pain is RO7 which is associated with pain in the throat and chest. It is a non-billable code as several codes come under it and have a greater level of detail.

There are five categories of ICD 10 codes that come under RO7. Only one of those categories has subtypes that correspond to specific chest pains. Here is a detailed explanation of this hierarchy:

ICD 10 Code R07.0

This code is associated with pain in the throat and can be used to indicate a diagnosis. It is billable and the ICD-9-CM code for throat pain is 784.1.

ICD 10 Code R07.1

This code is associated with chest pain on breathing. It is also billable and the ICD-9-CM code for painful respiration is 786.52.

ICD 10 Code R07.2

This code is associated with precordial pain and can be used to indicate a diagnosis. It is billable and ICD-9-CM code for precordial pain is 786.51.

ICD 10 Code R07.8

This code is associated with other forms of chest pain. It is non-billable due to its subtypes that can be applied to other detailed chest pains

• ICD 10 Code R07.81: You can assign R07.81 for Pleurodynia which is a medical condition. Patients feel pain either in their chest or upper abdomen when they breathe. It is a billable code and the ICD-9-CM code for Pleurodynia is 786.52.
• ICD 10 Code R07.82: This code applies to Intercostal pain which is a painful condition of the intercostal nerves. You can bill and the ICD-9-CM code for Intercostal pain is 786.59.
• ICD 10 Code R07.89: The R07.89 code can be associated with other chest pains that are not covered with other codes. It also corresponds to the ICD-9-CM 786.59 code since it is billable.

ICD 10 Code R07.9

This code is associated with an unspecified chest pain. It is billable and ICD-9-CM code for unspecified chest pain is 786.50.

Coding Guidelines for R07.9 Chest Pain

There are a lot of guidelines that you must follow while assigning ICD 10 codes. Here is a complete breakdown of them in detail:

• Appropriate Use and When to Avoid

Use the codes for chest pain only if there is a clear and documented complaint in the patient’s medical records. The documentation may lack specific details about the chest pain. These details can be about its exact location, severity, or associated symptoms.

This makes it impossible to assign a more specific chest pain code. As a result, healthcare providers can use the R07.9 code. Do not use R07.9 if you have enough details about the patient’s medical records. The details should be enough to assign a more specific chest pain code.

The chest pain can also be related to a diagnosed underlying condition. Common conditions comprise myocardial infarction (heart attack), pneumonia, and other specific illnesses. In such cases, you have to code the underlying condition instead of R07.9.

• Documentation and Specificity

Accurate and thorough documentation of the patient’s symptoms is crucial. This includes describing the characteristics of chest pain. The characteristics typically include its nature, duration, location, intensity, and any associated symptoms.

Ensure that the documentation clearly outlines any clinical findings and observations. Whenever possible, select specific codes only that accurately reflect the patient’s condition. Specific codes will help you better understand the patient’s health status.

You will also be able to provide appropriate care. Review the patient’s symptoms thoroughly as well. It will help you determine if there is enough information to use a more specific code rather than R07.9.

• External Causes

The chest pain may also result from an external cause. An example is trauma from injury in a car accident or a fall. In this case, you will have to code the external cause alongside R07.9. The codes associated with external causes provide additional context. They are important for comprehensive medical records and accurate reporting.

Example Scenarios of Assigning ICD 10 Codes

Consider these real-life scenarios that will give you an idea how to assign ICD 10 codes to specific medical cases:

• Scenario 1

This scenario is based on an appropriate Use of the R07.9 code. A patient may come into the emergency department complaining of chest pain. Their medical records note down the complaint of chest pain.

However, they have missed the details about its location, severity, and any associated symptoms. In this case, the R07.9 code is appropriate as there is not enough information to assign a more specific code for chest pain.

• Scenario 2

This scenario is based on avoiding R07.9 for chest pain. Consider a patient who presents with chest pain that occurs specifically when breathing. Their medical record shows that the pain is associated with breathing. It also provides details about its severity and other related symptoms.

The code assigned to this medical case will be R07.1 instead of R07.9. This is because it aligns the most with chest pain on breathing.

• Scenario 3

This scenario is based on an underlying condition associated with chest pain. A patient is diagnosed with a myocardial infarction. It is another name for heart attack and, as a result, the patient reports chest pain.

Their medical record describes that chest pain linked with the heart attack diagnosis. In this case, the code for myocardial infarction should be used. You should not use the R07.9 code here so that the underlying condition is accurately reflected.

The Bottom Line

The primary ICD 10 code for chest pain is R07.9. It can be directly converted to the ICD-9-CM 786.50 code. There are specific guidelines that you can follow to accurately assign ICD codes with different scenarios associated with chest pain. Contact Health Quest Billing and get a chance to work with the best medical coders in the market.