Gastroenterology Coding Alert

Question: Our provider tends to use the terms “epigastric pain” and “heartburn” interchangeably. Sometimes, the notes describing two conditions are identical, yet in one, the provider diagnoses epigastric pain, and the other, heartburn. Is this something I should bring up to my provider?

Virginia Subscriber

Answer: The provider likely understands the clinical difference between the two but they may not realize the difference from a coder’s perspective. When in doubt, show them the two different codes and ask for clarification whenever there is an apparent discrepancy.

Keep in mind though that neither R12 (Heartburn) or R10.13 (Epigastric pain) are not very specific; they just each describe symptoms. Epigastric pain occurs in the upper abdomen below the ribs, and heartburn is pain that radiates upward toward the throat. The provider should use the term that best describes the patient’s complaint.

Also, which code you report might not matter in terms of reimbursement, but the documentation should support the note. If the note says the diagnosis is epigastric pain, then report R10.13. If the note diagnosis heartburn, report R12.

Note: Another common diagnosis code for similar symptoms, such as pain, bloating, heartburn or nausea is K30 (Functional dyspepsia).