Code Description

ICD-10 R11 is a billable code used to indicate a diagnosis of nausea and vomiting.

Key Diagnostic Point:

Nausea and vomiting are common symptoms that can arise from a variety of underlying conditions. Nausea is characterized by a sensation of unease and discomfort in the stomach, often accompanied by an urge to vomit. Vomiting, or emesis, is the forceful expulsion of the contents of the stomach through the mouth. These symptoms can be acute or chronic and may be associated with gastrointestinal disorders, infections, metabolic disturbances, neurological conditions, or as side effects of medications. Clinical evaluation often involves a thorough history and physical examination, focusing on the onset, duration, and characteristics of the symptoms, as well as associated symptoms such as abdominal pain, diarrhea, or fever. Laboratory tests may include complete blood counts, metabolic panels, and imaging studies to identify potential causes. Accurate coding of R11 requires careful documentation of the symptoms and any relevant clinical findings, as well as consideration of the underlying etiology when applicable.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Variety of potential underlying causes
Need for detailed documentation of symptoms
Differentiation from other gastrointestinal codes
Potential for co-existing conditions

Audit Risk Factors

Inadequate documentation of symptom severity
Failure to specify acute vs. chronic symptoms
Misclassification of nausea/vomiting as primary diagnosis
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 nausea and vomiting due to gastroenteritis, medication side effects, or metabolic disorders.

Billing Considerations

Consideration of chronic conditions that may contribute to symptoms, such as diabetes or renal failure.

Emergency Medicine

Documentation Requirements

Acute care documentation including vital signs, physical exam findings, and any immediate interventions.

Common Clinical Scenarios

Patients presenting with acute abdominal pain and nausea/vomiting due to appendicitis or bowel obstruction.

Billing Considerations

Rapid assessment of potential life-threatening conditions that may present with nausea and vomiting.

Coding Guidelines

Inclusion Criteria

Use R11 When

Follow official ICD
CM guidelines for coding symptoms, ensuring that R11 is used when no specific diagnosis is established
Document the context of symptoms and any relevant clinical findings

Exclusion Criteria

Do NOT use R11 When

No specific exclusions found.

Related Codes

Child Codes

9 codes

Vomiting, unspecified

R11.11

Vomiting without nausea

R11.12

Projectile vomiting

R11.13

Vomiting of fecal matter

R11.14

Bilious vomiting

R11.15

Cyclical vomiting syndrome unrelated to migraine

R11.2

Nausea with vomiting, unspecified

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits for patients with chronic nausea and vomiting.

Documentation Requirements

Document the patient's history, review of systems, and any changes in treatment.

Specialty Considerations

Internal medicine may require more detailed chronic management documentation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of symptoms like nausea and vomiting, improving the ability to capture the complexity of patient presentations and their underlying causes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of symptoms like nausea and vomiting, improving the ability to capture the complexity of patient presentations and their underlying causes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of symptoms like nausea and vomiting, improving the ability to capture the complexity of patient presentations and their underlying causes.

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

When should I use R11 instead of a more specific code?

Use R11 when the symptoms of nausea and vomiting are present without a definitive diagnosis or when the underlying cause is not specified.