Outpatient Facility Coding Alert

Question: What is the diagnosis code for CVA tenderness?

Florida Subscriber

Answer: This is the sort of question that can easily trip up a coder without a strong universal clinical foundational knowledge. When most coders think of the acronym CVA, they immediately jump to “cerebrovascular accident.” However, in this example, CVA stands for “costovertebral angle.”

As you can see, this diagnosis does not involve the cerebrovascular system at all. Rather, a diagnosis of CVA tenderness is typically the result of the provider tapping the costovertebral angle (area on either side of the back between the twelfth rib and vertebral column) in order to further clarify a kidney stone diagnosis. If the patient experiences CVA tenderness, it’s often a clinical sign that the patient has kidney stones.

Since the area of the CVA corresponds with a patient’s flank, you should consider CVA tenderness and flank pain to be interchangeable terms. Within the ICD-10-CM index, pain → flank leads to see Pain, abdominal. There, you see that Pain → abdominal → tenderness leads you to see Tenderness, abdominal. Here, you should opt for code R10.819 (Abdominal tenderness, unspecified site) due to a lack of a more specific option for CVA tenderness.

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