R12
R12: Heartburn
Billable / specific codeICD-10-CM
R12 is a billable, specific ICD-10-CM code for heartburn. It is valid for submission on a claim.
Check R12 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)
Excludes2: not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- dyspepsia NOS (R10.13)
Other codes that can never be billed with R12
Their own Excludes1 notes name this code, so the conflict is not listed above.
- K30Functional dyspepsia
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
R12 is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56389Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
- A57063Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
- A57326Billing and Coding: Electrocardiograms
- A57414Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Alphabetic index entries that lead here
- Brash(water)
- Heartburn
- Pyrosis
- Waterbrash
Code history
Unchanged in every release from FY2024 to FY2027.