Epigastric abdominal pain, also known as upper central abdominal pain or upper abdominal pain, can be concerning. Learn about the causes of stomach pain, proper clinical documentation for epigastric pain, and relevant medical coding terms for accurate healthcare recordkeeping. Find information on diagnosis and treatment options for epigastric abdominal pain to aid in effective patient care.
Also known as
Symptoms and signs involving the abdomen and pelvis
Covers various abdominal symptoms, including epigastric pain.
Diseases of esophagus, stomach and duodenum
Includes conditions like gastritis and ulcers, potential causes of epigastric pain.
Disorders of gallbladder, biliary tract and pancreas
Conditions in these organs can sometimes present with epigastric pain.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the epigastric pain due to a known physiological condition?
Yes
Is it due to GERD?
No
Is the pain functional (non-organic)?
When to use each related code
| Description |
|---|
| Pain in the upper central abdomen. |
| Heartburn with chest or upper abdominal pain. |
| Generalized abdominal discomfort and pain. |
Coding R10.4 (abdominal pain, unspecified) instead of a more specific epigastric pain code when documentation supports it.
Misdiagnosing epigastric pain as GERD (gastroesophageal reflux disease) or vice versa, leading to inaccurate coding.
Insufficient documentation to support the diagnosis of epigastric pain, impacting accurate code assignment and reimbursement.
Q: What are the key differential diagnoses to consider in a patient presenting with acute epigastric abdominal pain radiating to the back?
A: Acute epigastric abdominal pain radiating to the back presents a broad differential diagnosis requiring careful clinical evaluation. Key considerations include acute pancreatitis, perforated peptic ulcer, cholecystitis, myocardial infarction, aortic dissection, and nephrolithiasis. Pancreatitis often presents with severe, constant pain accompanied by nausea and vomiting. A perforated ulcer may cause sudden, intense pain followed by peritonitis. Cholecystitis typically presents with right upper quadrant pain that may radiate to the back, often after a fatty meal. Myocardial infarction, although primarily a cardiac condition, can manifest as epigastric pain, especially in inferior wall MI. Aortic dissection requires urgent consideration due to its life-threatening potential, particularly if the pain is described as tearing or ripping. Nephrolithiasis can present with flank pain radiating to the groin, but may also cause epigastric pain. Accurate diagnosis hinges on thorough history-taking, physical examination including Murphy's sign and assessment for guarding and rebound tenderness, along with targeted laboratory investigations (amylase, lipase, cardiac enzymes, urinalysis) and imaging studies (ECG, abdominal ultrasound, CT). Explore how risk stratification tools can aid in prioritizing diagnostic workup for acute epigastric abdominal pain.
Q: How can I differentiate between GERD-related epigastric pain and more serious conditions like peptic ulcer disease or cardiac ischemia in a clinical setting?
A: Differentiating between GERD, peptic ulcer disease (PUD), and cardiac ischemia based on epigastric pain can be challenging as symptoms can overlap. GERD typically presents with burning retrosternal pain or discomfort, often worse after meals or when lying down, and relieved by antacids. PUD pain may be described as gnawing or burning, often occurring on an empty stomach and relieved by eating. Cardiac ischemia can manifest as epigastric pain or pressure, often radiating to the jaw, neck, or left arm, and associated with exertion or stress. Red flags suggesting a more serious diagnosis include pain radiating to the back, chest pain with exertion, diaphoresis, shortness of breath, nausea, vomiting, and melena. A detailed history, including symptom onset, character, location, radiation, aggravating and relieving factors, is crucial. Physical examination focusing on cardiovascular and gastrointestinal systems is essential. Consider implementing standardized diagnostic protocols including ECG, cardiac biomarkers (troponin), and upper endoscopy for patients with alarm symptoms or refractory symptoms. Learn more about the utility of the HEART score in evaluating patients with chest pain.
Patient presents with a chief complaint of epigastric abdominal pain. The onset of the upper abdominal pain, also described as stomach pain, was [duration] and is characterized as [quality of pain: e.g., sharp, dull, burning, cramping]. The pain is located in the upper central abdomen, specifically the epigastric region. The patient reports [associated symptoms: e.g., nausea, vomiting, dyspepsia, bloating, heartburn, early satiety, weight loss, melena, hematemesis]. Pain is [aggravating factors: e.g., exacerbated by meals, certain foods, lying down] and [relieving factors: e.g., relieved by antacids, sitting upright, empty stomach]. Patient denies [pertinent negatives: e.g., fever, chills, jaundice, changes in bowel habits, radiating pain]. Past medical history includes [relevant past medical history: e.g., GERD, peptic ulcer disease, gastritis, pancreatitis, gallbladder disease]. Medications include [list current medications]. Family history is significant for [relevant family history: e.g., history of ulcers, stomach cancer, gallbladder disease]. Physical examination reveals [relevant physical exam findings: e.g., tenderness to palpation in the epigastric region, normal bowel sounds, no rebound tenderness or guarding]. Differential diagnosis includes gastritis, gastroesophageal reflux disease (GERD), peptic ulcer disease, pancreatitis, cholecystitis, and other gastrointestinal disorders. Plan includes [diagnostic tests ordered: e.g., complete blood count (CBC), comprehensive metabolic panel (CMP), lipase, amylase, abdominal ultrasound, esophagogastroduodenoscopy (EGD)], and [treatment plan: e.g., dietary modifications, antacids, proton pump inhibitors (PPIs), H2 blockers, pain management]. Follow-up scheduled for [date/time]. Further evaluation and management will be based on diagnostic results.