R10.13: Epigastric pain
R10.13 is a billable, specific ICD-10-CM code for epigastric pain. It is valid for submission on a claim.
Check R10.13 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- functional dyspepsia (K30)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Dyspepsia
Excludes1 inherited from the categories above R10.13
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above R10.13
Not part of this code, but both may be coded when both are present.
Written on R10.1: Pain localized to upper abdomen
Other codes that can never be billed with R10.13
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
R10.13 is named in 27 Medicare coverage policies: 27 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A55336Billing and Coding: Retroperitoneal Ultrasound
- A56034Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
- A56389Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
- A56421Billing and Coding: CT of the Abdomen and Pelvis
Alphabetic index entries that lead here
- Dyspepsia
- Distress›epigastric
- Pain›epigastric, epigastrium
- Pain›abdominal›upper›epigastric
The condition this code belongs to
Code history
Unchanged in every release from FY2024 to FY2027.