Epigastric pain

This code represents pain localized to the upper central region of the abdomen, specifically the area above the navel and below the ribs. It indicates a symptom rather than a definitive diagnosis of an underlying condition.

Use this code when the medical record documents epigastric pain as a presenting symptom, and a more specific diagnosis for the cause of the pain has not yet been established or is not documented. It is appropriate for initial encounters or when the pain is the primary reason for the visit.

• Do not code this when a definitive diagnosis for the cause of the epigastric pain (e.g., gastritis, GERD, peptic ulcer) is documented.
• Be mindful of the Excludes1 note for functional dyspepsia (K30); these conditions should not be coded together.
• Sequence this code as the primary diagnosis when it is the chief complaint and no definitive etiology is identified.