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v1.0.0
ICD-10 Guide
ICD-10 CodesR07.0

R07.0

Billable

Pain in throat

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R07.0 is a billable code used to indicate a diagnosis of pain in throat.

Key Diagnostic Point:

Pain in the throat, classified under ICD-10 code R07.0, refers to discomfort or pain experienced in the throat region, which can be a symptom of various underlying conditions. This pain can be acute or chronic and may present as a sharp, dull, or burning sensation. Common causes include infections (such as viral or bacterial pharyngitis), allergies, gastroesophageal reflux disease (GERD), and irritants like smoke or pollutants. In some cases, pain in the throat may also be associated with systemic conditions such as autoimmune disorders or malignancies. The clinical presentation may vary, with patients reporting additional symptoms such as difficulty swallowing, hoarseness, or fever. A thorough clinical evaluation, including a detailed history and physical examination, is essential to determine the underlying cause. Laboratory tests, such as throat cultures or rapid strep tests, may be warranted based on the clinical suspicion. Accurate coding of R07.0 requires careful documentation of the patient's symptoms, duration, and any associated findings to ensure appropriate treatment and billing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes
  • Overlap with other throat-related codes
  • Need for detailed documentation of symptoms
  • Potential for misdiagnosis

Audit Risk Factors

  • Inadequate documentation of symptoms
  • Failure to specify acute vs. chronic pain
  • Misuse of related codes
  • Lack of supporting clinical findings

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed history of present illness, including onset, duration, and associated symptoms.

Common Clinical Scenarios

Patients presenting with sore throat, fever, and difficulty swallowing.

Billing Considerations

Consideration of comorbidities such as diabetes or immunocompromised states that may complicate diagnosis.

Emergency Medicine

Documentation Requirements

Acute care documentation including vital signs, rapid assessment of airway, and any immediate interventions.

Common Clinical Scenarios

Patients with acute throat pain presenting with respiratory distress or severe dysphagia.

Billing Considerations

Rapid identification of life-threatening conditions such as epiglottitis or anaphylaxis.

Coding Guidelines

Inclusion Criteria

Use R07.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code reflects the specific symptoms and clinical findings documented in the patient's medical record
  • Use additional codes as necessary to capture the underlying cause

Exclusion Criteria

Do NOT use R07.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits for throat pain management.

Documentation Requirements

Document the patient's history, examination findings, and treatment plan.

Specialty Considerations

Internal medicine may focus on chronic management, while ENT may focus on surgical interventions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of throat pain, improving the ability to capture the nuances of patient presentations and facilitating better data collection for epidemiological studies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of throat pain, improving the ability to capture the nuances of patient presentations and facilitating better data collection for epidemiological studies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of throat pain, improving the ability to capture the nuances of patient presentations and facilitating better data collection for epidemiological studies.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What should be documented to support the use of R07.0?

Document the patient's symptoms, duration, associated findings, and any relevant medical history to support the diagnosis of throat pain.