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v1.0.0
ICD-10 Guide
ICD-10 CodesR13.1

R13.1

Dysphagia

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

Code Description

ICD-10 R13.1 is a billable code used to indicate a diagnosis of dysphagia.

Key Diagnostic Point:

Dysphagia refers to difficulty swallowing, which can manifest as a sensation of food getting stuck in the throat or chest, pain during swallowing (odynophagia), or the inability to swallow altogether. This condition can arise from various underlying causes, including neurological disorders (such as stroke or Parkinson's disease), structural abnormalities (like esophageal strictures or tumors), or muscular disorders (such as myasthenia gravis). Patients may present with symptoms such as coughing or choking while eating, regurgitation, or unintentional weight loss due to avoidance of eating. Clinical evaluation often includes a thorough history and physical examination, followed by diagnostic tests such as a barium swallow study or endoscopy to assess the swallowing mechanism and identify any anatomical or functional abnormalities. Dysphagia can significantly impact a patient's quality of life and nutritional status, making timely diagnosis and management essential.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes requiring differential diagnosis
  • Potential for overlapping symptoms with other gastrointestinal disorders
  • Need for detailed documentation of patient history and symptoms
  • Variability in presentation based on age and comorbidities

Audit Risk Factors

  • Inadequate documentation of the underlying cause of dysphagia
  • Failure to specify the type of dysphagia (e.g., oropharyngeal vs. esophageal)
  • Misclassification of dysphagia as a symptom of another condition
  • Lack of supporting clinical evidence for the diagnosis

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Comprehensive patient history, including onset, duration, and associated symptoms of dysphagia.

Common Clinical Scenarios

Patients presenting with chronic dysphagia due to esophageal strictures or neurological conditions.

Billing Considerations

Consideration of comorbidities that may complicate dysphagia, such as diabetes or heart disease.

Emergency Medicine

Documentation Requirements

Acute assessment of dysphagia, including vital signs and immediate interventions.

Common Clinical Scenarios

Patients with acute onset of dysphagia following a stroke or foreign body ingestion.

Billing Considerations

Rapid evaluation and management of airway compromise due to dysphagia.

Coding Guidelines

Inclusion Criteria

Use R13.1 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the patient's clinical presentation and any relevant diagnostic findings
  • Use additional codes to capture underlying conditions contributing to dysphagia

Exclusion Criteria

Do NOT use R13.1 When
No specific exclusions found.

Related CPT Codes

92610CPT Code

Evaluation of swallowing function

Clinical Scenario

Used when assessing dysphagia in a patient with neurological conditions.

Documentation Requirements

Document the patient's swallowing assessment results and any interventions performed.

Specialty Considerations

Neurologists may frequently use this code in conjunction with R13.1.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of dysphagia, enabling better tracking of underlying causes and improving the quality of care through targeted interventions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of dysphagia, enabling better tracking of underlying causes and improving the quality of care through targeted interventions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of dysphagia, enabling better tracking of underlying causes and improving the quality of care through targeted interventions.

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 is the difference between R13.1 and R13.0?

R13.1 is used for dysphagia with a specified cause, while R13.0 is for unspecified dysphagia. Accurate documentation is essential to determine which code to use.