Chest pain is one of the most common reasons people visit the emergency room. Chest pain can vary from person to person. It can feel like a sharp sting or a dull pain.
It can also be a sign of a more serious heart problem. If you have chest pain, your first thought might be that you have a heart attack. But chest pain is a suspected sign of a heart attack and it can be caused by many other serious conditions. Many common causes are not life-threatening, but can cause them. According to the National Center for Health Studies (NCHS), only 13 percent of the emergency room visits to chest pain lead to a diagnosis of a serious heart problem.
But chest pain does not mean that it is associated with a serious heart disease or a heart attack. Instead, chest pain is a common complaint that can be a symptom of a more serious illness.
(Non) Ischemic Cardiac Diagnoses
Examples of ischemic heart diseases are angina pectoris, heart attack, aortic stenosis, hypertrophic cardiomyopathy and coronary vasospasm. Examples of non-ischemia cardiac causes of chest pain include pericarditis, aortic section and mitral valve prolapse. Examples of non-cardiac causes are gastroesophageal, pulmonary, musculoskeletal and dermatological events. The features of chest pain depend on the cause and can be classified as ischemic, non-ischemic or noncardiac or gastroesphageal / pulmonary / muscular.
Costochondritis, rib fractures and compression fractures are examples of musculoskeletal causes. Pneumothorax, pulmonary embolism, pleurisy, neoplasm and bronchitis are pneumonia. An example of gastroesophageal reflux (esophagitis, esophageal cramp, esphageal perforation, gastritis, peptic ulcers and achalasia) is an example of gastroesophageal causes. A dermatological cause is herpes zoster or shingles. Anxiety and panic attacks lead to chest pain accompanied by extreme anxiety, rapid heartbeats, rapid breathing (hyperventilation), excessive sweating and shortness of breath.
Patients who come to the emergency room complaining of chest pain can feel chest pain after being hit by a ball, fell or another injury or trauma. This is a classic example of noncardiac musculoskeletal atypical chest pain and the final diagnosis should document this. The coder can also focus on chest pain in other areas to prepare for ICD-10cm.
Costochondrial pain is chest pain caused by inflammation of cartilage in the chest (costochondritis) and mimics the pain of heart attacks and other heart diseases. Precordial pain, also known as precordial angiopathy syndrome, is characterized by the sudden appearance of sharp, stabbing pain in the chest. Painful breathing, discomfort or pain when inhaling or exhaling can be underlying causes such as infections, injuries to the musculoskeletal system or heart problems. Chest wall syndrome is a stress injury caused by direct or so-called chest wall pain.
Precordial pain is one of the most common types of chest pain in children and adolescents. The other common causes are respiratory disease, heart disease and tumors. Pain in the sternum or chest caused by gastrointestinal problems such as GERD. Subinpatient pain in the sternum caused by a gastrointestinal problem.
Severe and sudden pain in the ribs and the upper back after a sudden thigh blow, overexertion or muscle weakness. Pleurodynia or pectoral pain is a severe, acute pain of the rib or diaphragm muscles.
Pain in front chest wall Pain in the chest wall or in the musculoskeletal area are one of the most common causes of noncardiac chest pain. Breast tension is caused by an active stress response (escape or fight reaction ). The tightness in the chest can be caused by serious causes such as heart attack, asthma, pulmonary hypertension, ulcers, broken ribs, GERD or muscle strains.
By default, ICD-10 code for chest pain is R079. The chest pain is not specified. Documentation is the key to accurately code chest pain. An alphabetical index is required to refer to the following tabular list of exact encoding. Additional documents specifying chest pain are required for accurate encoding in the following list. If chest pain can be attributed to an underlying disease, the diagnosis must be confirmed by documentation prior to encoding, otherwise chest pain is not encoded.
ICD-10-CM Code Category For Chest Pain
R07: Pain in throat and chest.
R07.8: Other chest pain.
ICD-10-CM Codes For Chest Pain
R07.0: Pain in throat/ larynx.
R07.1: Chest pain on breathing, painful respiration, costochondral pain, pain in diaphragm, chest wall syndrome &prinzmetal massumi syndrome.
R07.2: Precordial pain, retrosternal pain &substernal.
R07.81: Pleurodynia, pleuritic pain, pleuralgia & pain in rib.
R07.82: Intercostal pain.
R07.89: Other chest pain, anterior chest wall pain, atypical chest pain, musculoskeletal, non-cardiac chest pain, chest pressure, chest tightness & anterior chest wall syndrome.
R07.9: Chest pain (unspecified) & central chest pain.
Example 1: ICD 10 Code For Chest Pain
A 60-year-old male patient named Chris was taken by the chief to the emergency room with a complaint of acute intercostal chest pain after being kicked in the chest. The patient did not have any history of gastroesophageal reflux disease. An ECG and laboratory tests were completed, but no underlying heart disease or MI was ruled out.
Code: Ans– R07.89 (Atypical chest pain), I20.9 (Angina), K21.9 (GERD)
Example 2: ICD 10 Code For Chest Pain
A 21-year-old patient was taken to the hospital with a report of chest pain.
Code: Ans– R07.82 (intercostal chest pain), G89.11 (acute pain due to trauma)
A Last Note
When assigning an ICD-10cm code to a heart attack, the encoder must know which arterial wall is involved in the event. It is important to note that the rules for myocardial infarction (MI) may not document these rules unless the physician documents them when the patient is hospitalized, and this can make coding difficult. If the doctor diagnoses an MI in a patient with chest pain, the doctor should document the rules. If these rules are not documented, ask for clarification.
Another thing to keep in mind for coders is that one should not assume that chest pain is not cardiac unless there is a cardiac diagnosis. In such cases it is recommended to ask a doctor for clarification of a suitable chest pain coded.