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Common ICD-10 Family Practice CODES

Abdominal Pain
Back and neck pain (Selected)
Chest Pain
Diabetes Mellitus w/o Complications Type 2
General Medical Examination


(ICD-10-CM R10.0)

R10.0 Acute Abdomen

ICD-Code R10.0 is a billable ICD-10 code for reimbursements for the healthcare diagnoses of acute abdomen. It is transmitted from ICD-9 code 789.00. It is used to represent the diagnosis of acute abdominal pain that is severe, localized, and rapid onset.

Acute abdomen is caused due to a variety of reasons i.e. disorders, injuries, or diseases. It is also used for other synonyms such as acute abdominal pain, recurrent abdominal pain, and several abdominal pain.


(ICD-10-CM Code for Cervicalgia M54. 2)

2023 ICD-10-CM Diagnosis Code M54.2

M54.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2023 edition of ICD-10-CM M54.2 became effective on October 1, 2022. This is the American ICD-10-CM version of M54.2 which could be different from the international versions of the ICD-10 M54.2 code. It is used to represent the diagnosis of back and neck pain.

It is caused due to poor muscle tone, abnormal organ growth (i.e. tumor), infection, overuse or improper use ( such as repetitive or heavy lifting), injury, or obesity. ICD-10 M54.2 can also be used for other synonyms i.e. Neck pain, acute neck pain, chronic pain in the cervical spine, pain in the cervical spine, and cervical (neck) spine pain.


(ICD-10-CM J00 to J06 & J20 to J22)

Upper respiratory infections (URIs) are infections of the mouth, nose, throat, larynx (voice box), and trachea (windpipe). Nasopharyngitis (common cold) is the major cause of URIs, and most patients (80%) that are diagnosed with nasophyaryngitis have nasal congestion.

The common causes of nasophyaryngitis are viral. Usually, common cold is treated symptotically and hand washing is the best prevention.

Acute lower respiratory infections include pneumonia (infection of the lung alveoli), as well as infections that can affect airways such as acute bronchitis and bronchiolitis, influenza and whooping cough.

Acute lower respiratory infections are a leasing cause of illness and death in children and adults around the globe. There are 2 major types of bronchitis i.e. acute and chronic. Staying committed to the subject, we’ll only discuss about acute lower respiratory infection.

The major cause of acute lower respiratory infections are viruses that cause cols and the flu. Such viruses also cause infections like acute bronchitis. These viruses spread through physical touch or any kind of contact though air like coughing and sneezing.

Patients that are regularly exposed to tobacco smoke, air pollution, dusts, vapors, and fumes can also cause acute bronchitis. Another leading cause of acute bronchitis is bacteria but they don’t trigger this disease as often as viruses.

This disease is often treated with fluids, rests, and aspirin (for adults) or acetaminophen. Its treatment also include humidifier/ steam and inhaled medicine to open your airways if the patient is wheezing.

ICD-10-CM codes ranging from J00 to J06 are used to translate acute upper respiratory infections and j20 to j22 for acute lower respiratory infections.

CHEST PAIN, Unspecified

(ICD-10-CM R07.9)

R07.9 is a bilable/specific ICD-10-CM code that is used to indicate a diagnosis of chest pain for reimbursement purposes. R07.9 is the 2023 edition of ICD-10 which became effective on October 1, 2022. However, it is the American version of ICD-10-CM R07.9 which could be different from the international version of this code.


(ICD-10-CM E11.90 and E11.91 Type 2 diabetes mellitus without complications)

The insulin hormone (released by pancreas) is responsible to absorb sugar from blood into the cells. If this hormone doesn’t work properly then it increases the sugar level of blood after eating. E11.90 is a billable/specific ICD-10-CM code this is used to indicate the diagnosis of Type 2 Diabetes mellitus without complications controlled.

The major causes of type diabetes mellitus include; excessive fatty tissue in the body, insufficient exercise or improper nutrition, or there may be hereditary causes.

When the insulin hormone stop working properly in the body then it rises sugar level in the blood to such an extreme level that it can damage blood vessels and nerves. Therefore, it’s symptoms can appear at various body parts. In order to treat type 2 diabetes mellitus, patients take injections of insulin hormone to balance the sugar level in blood.

However, excessive insulin can also drop the sugar level in blood which has adverse effects on the health as well. Therefore, the only cure to this disease is to intake proper healthy meals, regular exercise and balanced amount of insulin dose to maintain the sugar level in blood.

E11.91 is a billable/reimbursable code for Type 2 diabetes mellitus without complication uncontrolled.


(ICD-10-CM R51, R51.0 & R51.9)

Headache is a common disorder that is characterised by the sensation of marked discomfort in the face or on head but it is not confined to any area of distribution of nerve. ICD-10-CM is not a billable/reimbursable code for headache because there are other codes that define the specificity of this disorder under this code.

For example, R51.0 is a billable code to indicate the diagnosis of headache with orthostatic component, NEC used for reimbursement purposes. Moreover, R51.9 is a billable code use to indicate the diagnosis of headache, unspecified for reimbursement purposes.

ICD-10 Coding Guidelines For Family Practice

A family practice specialist deals with patients of all ages, making this field of medicine the most unique of all. Therefore, it requires in-depth knowledge of all the medical procedures and diagnoses involved in a family practice to deliver premium quality medical coding services.

Since family practice healthcare providers usually specialise in more than one medical field, which makes it even harder to comply with their all responsibilities and filing medical bills for their hard-earned services efficiently and accurately simultaneously.

However, well-experienced family practice medical billing and coding specialists can tune their workflow in order to pace with the busy schedule of family practitioners by adopting the following strategies.

  1. Set Your Goal Beforehand
  2. While generating revenue is the primary objective of family practice medical billing and coding specialists, however, they have to take some measures to reach their goal that are as follows:

    • Increase clean claim rate (claims that are error-free and get reimbursed at the first attempt of submission). For this purpose, family practice medical billers and coders should deploy innovative billing solutions that can automate their workflow, prevent human errors and verify documentation before carrying out billing tasks.
    • Make sure that they comply with the timelines of all inusrance payers to submit clean medical claims before the given deadline of payers. If medical claims are submitted on time then it reduces the number of claim denials/rejection which definitely improve the revenue flow across the healthcare practice.
    • Deploy reliable solutions for claim denial management everytime to combat revenue related problems smartly. No matter how hard you try to verify documents, coverage plan and eliminate errors, claim denials are inevitable in family practice. Because nobody can predict when billing and coding rules, patient’s demographics and payer’s requirements can change. However, even if you have received a claim denial then it’s your responsibility to scrub the claim and appeal the insurance company on time. For this purpose, a healthcare provider should have a dedicated team of medical billing experts that are dedicated to manage claim denials and follow up with the insurance companies.
    • When working for a family practice, a medical billing specialist should leave a medical claim unattended after submission. Instead, an expert medical biller follow up with all medical claims from clearing houses to insurance companies for adjudication. If a clearing house indicates the revision of claim denials then your medical billing team should adjudicate claims and resubmit to collect reimbursement without more delays.
    • Lastly, family practice medical billers are the financial power house of your practice. Therefore, they should regularly remind your payers to collect your reimbursements on time. If any insurance company or patient is making delays with payments then your team should contact them anyway to inform them about their financial responsibilities. Sometimes, patients are unable to understand their billing statements, therefore, family practice medical billers should guide them and family practitioners should provide multiple payment methods to patients so they can pay their dues at their earliest convenience.


  3. Stay Updated With Changes & Updates Of Medical Codes:
  4. One of the biggest challenges for family practice coding specialists is to comply with constant changes in ICD and CPT codes. Family practice’s most revenue comes from ICD-10 and CPT codes. That’s why, family practice medical coders should verify and use accurate medical codes while preparing medical claims.

    Every year, ICD codes manuals and documentation guidelines are updated for the healthcare providers. Therefore, medical coders should make sure that they use the most upgraded form of ICD codes in the way healthcare insurance companies recognize them.

    For example, the industry has moved from ICD-9 to ICD-10 then ICD-10-CM codes, and those medical coders who aren’t acquaint with these updates are more likely to apply wrong medical codes in medical claims.

    In such cases, when medical claims are submitted to insurance companies then they are denied or rejected. Therefore, its important to update the amendments in codes to submit error-free medical claims.

  5. Justify Necessity Of The Service Provided:
  6. Prior authorization or precertification is the process to ensure that service, prescription of lab test that is going to be delivered to the patient is covered by their insurance plan. Prior authorization is carried out before the services, products or medications are delivered to the patient.s that are used to deliver cardiology care and diagnostic services.

    If the medical staff won’t proceed with prior authorization then they can never come to know who is the right payer of patient. It increases the chance of submitting medical claims to wrong payers. Therefore, medical billing and coding specialists should verify patient’s coverage plan and submit medical claims to the right payers.

  7. Ensure Accuracy Of Medical Codes:
  8. As mentioned earlier that family practice medical coding specialists should use the most latest version of medical codes (i.e. approved by the legal institutes and recognized by insurance companies).

    Moreover, medical coders should represent specificity of the disease, service or medication with accurate modifiers and specifiers. For example, in case of headache, ICD-10-CM R51 is not a billable code because there are other codes that define the specificity of headache under this codes i.e. R51.0 is billable code used specifically for headache with orthostatic component.

  9. Avoid Error In Documenting E/M services:
  10. E/M services(Evaluation and Management) is the medical coding process to support the medical billing process and get reimbursements from Centers for Medicare and Medicaid (CMS).

    ealthcare providers require E/M coding services to report their services for (that are delivered for decision making) during inpatient services, hospital visits and outpatient facility visits. The three major components of E/M coding services are as follows;

    • Patient history
    • Examination
    • Medical Decision Making (MDM)

    When family practice medical coders are using E/M codes then they should verify documents and use appropriate level of codes to avoid any ambiguity or error during family practice coding services.

  11. Using The Accurate Modifier:
  12. Using a modifier comes with a set of special requirements. Family practice coding specialists should understand the specificity of these requirements to use accurate modifiers. Incorrect modifiers cause claim denials that trigger delayed payments and lower reimbursements rates.

If you’re running an independent family practice or associated with a health organisation, CureCloudMD provides the most reliable and cost-effective medical billing services to all sizes of family practices. Schedule a free demo of our family practice medical billing and coding outsourcing services for an added boost of business productivity.