Gastroenterology Coding Alert

Question: I have a question about epigastric pain versus heartburn. We have one physician who seems to think these terms are interchangeable, and even if the notes are identical, he may use one term versus the other. But the codes are different — we’ve been instructed to use R12 (Heartburn) for heartburn and R10.13 (Epigastric pain) for epigastric pain, so we want to educate the physician but aren’t sure how to describe the differences to him from a coding standpoint, since we don’t quite know the specific differences from a medical standpoint. Can you help us find the intersection that both the coder and the physician will understand so everyone can know how to differentiate these two terms?

Codify Subscriber

Answer: The provider should use the term that best describes what patient is complaining about; epigastric pain is the upper abdomen region below the rib cage, and heartburn is a discomfort or pain that radiates upward along the sternum toward the throat.

They can overlap, and then there’s a choice. Ordinarily, this shouldn’t matter for reimbursement purposes, but the diagnosis should be supported by the note, and if the note describes epigastric pain, then the ICD-10 code should be R10.13. Neither are specific codes, they are both just symptom descriptions, but at the time of the encounter if the provider can’t be more specific, the R codes will be sufficient to collect for the service.