R10.11 ICD-10-CM Code: Right upper quadrant pain

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for R10.11 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on R10.11 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for R10.11

MedCoder structured workflow — derived from this code’s own official record

Before you code R10.11

1. Check whether an established diagnosis that explains this sign or symptom is documented. If one is, review whether the documented diagnosis changes the coding pathway: a symptom that is integral to a confirmed diagnosis is not reported separately, while one not routinely associated with it may be. Signs and symptoms are reported when no definitive diagnosis is established (Guidelines I.B.4, I.B.5, I.B.6, I.C.18.b).

   Guide: Symptom code vs confirmed diagnosis →

2. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: right). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

   ReviewR10.12 · left

   Guide: Laterality coding →

3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with R10.11. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

   See the official tabular notes

Choose the right path

1. Is an established diagnosis that explains this sign or symptom documented?
   Yes → Review whether the documented diagnosis changes the coding pathway: a symptom integral to it is not reported separately.
   No → Continue — the sign or symptom code stands when no definitive diagnosis is established.
2. Does the documentation support a condition named in R10.11’s Excludes1 note?
   Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
   No → Continue.

   ReviewN23

3. Is the side documented?
   Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
   No → Use the unspecified-side code only when the record states no side; a query is the alternative.

   ReviewR10.12 · left

Consider R10.11. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Laterality

Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).

Official instructions as workflow

• Excludes1 — check before selecting R10.11(1 note)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with R10.11: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareN23

  See the official tabular notes · Guidelines I.A.12.a

• Excludes2 — not part of R10.11(14 notes)

  Coding workflow: The conditions named in this note are not included in R10.11. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareR10.A, R10.2, R39.85, M54, R14, Q40.0

  See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Pain (s), abdominal, upper, right quadrant

Don’t confuse R10.11 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of R10.11 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• N23— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of renal colic moves the case to N23; the two are not reported together unless documented as unrelated.

  Full comparison: R10.11 vs N23 →

• R10.10— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Upper abdominal pain, unspecified” takes R10.10; specificity in the record moves it back here.

  Full comparison: R10.11 vs R10.10 →

• R10.12— Laterality relationship (Review)

  Same condition; these differ only in which side is documented.

  The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

  What moves you there: A documented left side moves the case to R10.12.

  Full comparison: R10.11 vs R10.12 →

• R10.A— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of pain localized to flank adds R10.A; it is not part of this code and both may be reported when both are documented.

  Full comparison: R10.11 vs R10.A →

• R10.2— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of pelvic and perineal pain adds R10.2; it is not part of this code and both may be reported when both are documented.

  Full comparison: R10.11 vs R10.2 →

• R39.85— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of costovertebral (angle) tenderness adds R39.85; it is not part of this code and both may be reported when both are documented.

  Full comparison: R10.11 vs R39.85 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

1. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
3. 14 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name R10.11 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: R52 — Pain, unspecified (via R10.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 6 Excludes2 notes across 2 chapters: G89 — Pain, not elsewhere classified (via R10.-), R10.2 — Pelvic and perineal pain (via R10.1.-), R10.81 — Abdominal tenderness (via R10.1.-), R10.82 — Rebound abdominal tenderness (via R10.1.-), R10.A — Pain localized to flank (via R10.1.-), R39.85 — Costovertebral (angle) tenderness (via R10.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 391 (MDC 06), DRG 392 (MDC 06).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):SYM006 — Abdominal pain and other digestive/abdomen signs and symptoms (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

R10.12 — Left upper quadrant painCompare R10.11 vs R10.12 →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Abdominal pain and other digestive/abdomen signs and symptoms).

G43.D0 — Abdominal migraine, not intractable, G43.D1 — Abdominal migraine, intractable, R10.0 — Acute abdomen, R10.10 — Upper abdominal pain, unspecified, R10.12 — Left upper quadrant pain, R10.13 — Epigastric pain, R10.2 — Pelvic and perineal pain, R10.20 — Pelvic and perineal pain unspecified side, R10.21 — Pelvic and perineal pain right side, R10.22 — Pelvic and perineal pain left side, R10.23 — Pelvic and perineal pain bilateral, R10.24 — Suprapubic pain, R10.30 — Lower abdominal pain, unspecified, R10.31 — Right lower quadrant pain, R10.32 — Left lower quadrant pain, R10.33 — Periumbilical pain, R10.811 — Right upper quadrant abdominal tenderness, R10.812 — Left upper quadrant abdominal tenderness, R10.813 — Right lower quadrant abdominal tenderness, R10.814 — Left lower quadrant abdominal tenderness, +58 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Pain”; these codes share that main term but sit in a different category of the Tabular List.

N94.3 — Premenstrual tension syndrome (premenstrual), N94.6 — Dysmenorrhea, unspecified (menstrual), N94.89 — Other specified conditions associated with female genital organs and menstrual cycle (ovary), R07.0 — Pain in throat (throat), R07.1 — Chest pain on breathing (diaphragm), R07.2 — Precordial pain (precordial), R07.81 — Pleurodynia (chest, pleurodynia), R07.82 — Intercostal pain (intercostal), R07.89 — Other chest pain (rib), R07.9 — Chest pain, unspecified (chest), R14.1 — Gas pain (gas), R39.82 — Chronic bladder pain (bladder, chronic), R39.89 — Other symptoms and signs involving the genitourinary system (vesical), R51.9 — Headache, unspecified (face, facial), R52 — Pain, unspecified, R68.84 — Jaw pain (jaw), T82.847 — Pain due to cardiac prosthetic devices, implants and grafts (due to device, implant or graft, heart NEC), T82.848 — Pain due to vascular prosthetic devices, implants and grafts (due to device, implant or graft, vascular NEC), T83.84 — Pain due to genitourinary prosthetic devices, implants and grafts (due to device, implant or graft, genital NEC), T84.84 — Pain due to internal orthopedic prosthetic devices, implants and grafts (due to device, implant or graft, orthopedic NEC), +59 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Fecal Occult Blood Test (FOBT), Hepatitis Testing, Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of R10.11 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run R10.11 with these 7 related codes in Claim Check

Hierarchy

• R00-R99 — Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) (R00-R99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R10-R19 — Symptoms and signs involving the digestive system and abdomen[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• R52 — Pain, unspecified[Excludes1](via R10.-): “abdomen pain (R10.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

• G89 — Pain, not elsewhere classified[Excludes2](via R10.-): “abdomen pain (R10.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R10.2 — Pelvic and perineal pain[Excludes2](via R10.1.-): “pain localized to upper abdomen (R10.1-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R10.81 — Abdominal tenderness[Excludes2](via R10.1.-): “pain localized to upper abdomen (R10.1-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R10.82 — Rebound abdominal tenderness[Excludes2](via R10.1.-): “pain localized to upper abdomen (R10.1-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R10.A — Pain localized to flank[Excludes2](via R10.1.-): “pain localized to upper abdomen (R10.1-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R39.85 — Costovertebral (angle) tenderness[Excludes2](via R10.-): “abdominal and pelvic pain (R10.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• SYM006 — Abdominal pain and other digestive/abdomen signs and symptoms[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 391 — ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC[MS-DRG]: “ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC (MDC 06)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 392 — ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC[MS-DRG]: “ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC (MDC 06)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 06 — Diseases and Disorders of the Digestive System[MDC crossing]: “Diseases and Disorders of the Digestive System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,744 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Pain (s), abdominal, upper, right quadrant[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

• R10 — Abdominal and pelvic pain[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R10.0 — Acute abdomen[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R10.1 — Pain localized to upper abdomen[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R10.10 — Upper abdominal pain, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R10.12 — Left upper quadrant pain[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R10.13 — Epigastric pain[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R10.2 — Pelvic and perineal pain[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R10.20 — Pelvic and perineal pain unspecified side[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 32 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to R10.11 in its code family, with their registry titles.

• R10 — Abdominal and pelvic pain
• R10.0 — Acute abdomen
• R10.1 — Pain localized to upper abdomen
• R10.10 — Upper abdominal pain, unspecified
• R10.12 — Left upper quadrant pain
• R10.13 — Epigastric pain
• R10.2 — Pelvic and perineal pain
• R10.20 — Pelvic and perineal pain unspecified side
• R10.21 — Pelvic and perineal pain right side
• R10.22 — Pelvic and perineal pain left side

View all codes in the R10 family