Is R10.816 a billable ICD-10-CM code?

Yes. R10.816 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does R10.816 sit in the tabular list?

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), in the block Symptoms and signs involving the digestive system and abdomen (R10-R19).

What cannot be coded together with R10.816?

R10.816 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above R10.816 (R10) and apply to it just the same.

R10.816

R10.816 — Epigastric abdominal tenderness

Billable / specific codeICD-10-CM

R10.816 is a billable, specific ICD-10-CM code for epigastric abdominal tenderness. It is valid for submission on a claim.

Excludes1 inherited from the categories above R10.816

These are not written on R10.816, but they bind it: a note on a category applies to every code beneath it. Billing R10.816 with anything listed here is a denial.

Written on R10 — Abdominal and pelvic pain

renal colic (N23)

Excludes2 inherited from the categories above R10.816

Also inherited, and the opposite of Excludes1: these conditions are not part of R10.816, but a patient can have both, so you may code both.

Written on R10.81 — Abdominal tenderness

pain localized to other parts of lower abdomen (R10.3-)
pain localized to upper abdomen (R10.1-)

Written on R10 — Abdominal and pelvic pain

costovertebral (angle) tenderness (R39.85)
dorsalgia (M54.-)
flatulence and related conditions (R14.-)

Other codes that can never be billed with R10.816

These codes carry an Excludes1 note pointing at R10.816. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading R10.816 alone.

R52Pain, unspecified

Risk adjustment

R10.816 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

R10.816 is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56421Billing and Coding: CT of the Abdomen and Pelvis
A57063Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
A58963Billing and Coding: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

How R10.816 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to R10.816.

Tenderness, abdominal›epigastric

The condition this code belongs to

Every code for the condition on one page, which one applies when, and the mistake coders make with it.

Abdominal pain ICD-10 codes

Code history

R10.816 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share R10.81. If R10.816 is not quite right, the correct code is usually one of these.

Questions about R10.816

Is R10.816 a billable ICD-10-CM code?: Yes. R10.816 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does R10.816 sit in the tabular list?: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), in the block Symptoms and signs involving the digestive system and abdomen (R10-R19).
What cannot be coded together with R10.816?: R10.816 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above R10.816 (R10) and apply to it just the same.