R07.9 — Chest pain, unspecified

Clinical Definition

Chest pain is one of the most frequent presenting complaints in emergency departments, urgent care facilities, and primary care offices. It encompasses any pain, pressure, tightness, burning, or discomfort perceived in the anterior, lateral, or posterior thoracic region between the neck and the upper abdomen. The differential diagnosis for chest pain is broad, spanning cardiac etiologies (acute coronary syndrome, pericarditis, aortic dissection), pulmonary causes (pulmonary embolism, pneumothorax, pleuritis), gastrointestinal conditions (gastroesophageal reflux, esophageal spasm), musculoskeletal disorders (costochondritis, rib fracture), and psychogenic origins (panic disorder, anxiety). Given the potentially life-threatening nature of certain etiologies, chest pain demands prompt triage and systematic evaluation.

ICD-10-CM code R07.9 is a symptom code used when the provider documents chest pain without specifying the type, location, or underlying etiology at the time of the encounter. It is classified as 'chest pain, unspecified' and serves as a catch-all within the R07 category when more specific codes — such as R07.1 (chest pain on breathing), R07.2 (precordial pain), R07.89 (other chest pain), or I20.9 (angina pectoris, unspecified) — are not supported by the clinical documentation. R07.9 should not be used when the provider has identified a definitive cause of the chest pain, such as acute myocardial infarction (I21.x), costochondritis (M94.0), or gastroesophageal reflux disease (K21.0), in which case the underlying diagnosis takes precedence per ICD-10-CM coding guidelines.

In emergency department and acute care settings, R07.9 is frequently assigned when the initial workup — including ECG, troponin levels, chest radiography, and clinical assessment — has not yet yielded a specific diagnosis, or when the patient is discharged with chest pain of undetermined origin after a negative acute evaluation. Coders should work closely with providers to capture the maximum level of specificity available in the documentation. When the chest pain is further characterized (e.g., pleuritic, substernal, musculoskeletal), a more specific R07 code should be used instead of R07.9 to avoid unnecessary claim scrutiny and to improve data quality for clinical analytics and population health management.

When to Use R07.9

• ✓The patient presents with chest pain and the provider documents it without specifying the type, location, or etiology at the time of the encounter — the workup is in progress or inconclusive.
• ✓The patient is evaluated in the emergency department for chest pain, the acute cardiac workup (ECG, troponin, chest X-ray) is negative, and the patient is discharged with a diagnosis of 'chest pain, unspecified' or 'noncardiac chest pain, NOS.'
• ✓The provider documents chest pain as a presenting complaint on the problem list or assessment without further qualifying it as pleuritic, precordial, musculoskeletal, or attributable to a specific disease.
• ✓A patient reports new-onset chest pain during a primary care visit and the provider orders diagnostic studies to evaluate the symptom — no definitive diagnosis has been established at the close of the encounter.
• ✓The provider documents 'atypical chest pain' without attributing it to a specific cardiac or non-cardiac diagnosis, and the documentation does not support a more specific R07 subcategory.
• ✓Chest pain is documented as a secondary diagnosis during a hospitalization where the primary condition is unrelated, and the type of chest pain is not further specified in the record.

Common Coding Mistakes

Related & Differential Codes

Documentation Requirements

• 1Location and characterization: specify where the chest pain is localized (substernal, left-sided, precordial, diffuse, chest wall) and its quality (sharp, dull, pressure, burning, squeezing) to support the most specific code selection.
• 2Onset and duration: document whether the chest pain is acute, subacute, or chronic, including the precise timeline of onset, to guide the urgency of evaluation and support medical necessity.
• 3Severity: document pain severity using a standardized scale (e.g., 0-10 numeric rating) and any changes in intensity with position, activity, or respiration.
• 4Associated symptoms: document concurrent symptoms such as shortness of breath, diaphoresis, nausea, palpitations, syncope, radiating arm or jaw pain, or anxiety, as these findings influence the differential diagnosis and code specificity.
• 5Provocative and palliative factors: document what worsens the pain (exertion, deep breathing, palpation, eating) and what relieves it (rest, nitroglycerin, antacids, positional change), as this guides both clinical management and accurate code assignment.
• 6Objective findings and diagnostic results: document vital signs, cardiac and pulmonary examination findings, ECG interpretation, troponin levels, chest X-ray results, and any additional studies (CT angiography, echocardiography, stress test) performed during the encounter.
• 7Risk stratification: document the provider's clinical assessment of cardiac risk (e.g., HEART score, TIMI score) and the clinical decision-making process to support the level of evaluation and management billed.
• 8Underlying cause if identified: when the workup reveals a specific etiology for the chest pain, document the definitive diagnosis to support transition from R07.9 to the appropriate disease-specific code.

Reimbursement & Billing Notes

ICD-10-CM code R07.9 is a valid, billable code accepted by Medicare, Medicaid, and commercial payers for encounters involving chest pain. It is one of the most commonly reported diagnosis codes in emergency medicine, supporting medical necessity for a comprehensive acute evaluation including ECG, cardiac biomarkers (troponin, CK-MB), chest radiography, CT angiography (when pulmonary embolism or aortic dissection is suspected), echocardiography, and observation status. R07.9 is appropriate as the primary diagnosis when the evaluation does not yield a specific underlying cause at the time of discharge or encounter closure.

However, R07.9 does not map to a CMS-HCC risk adjustment category, so it does not contribute to risk-adjusted capitation payments in Medicare Advantage or similar value-based programs. Payers and auditors may scrutinize repeated use of R07.9 across multiple encounters for the same patient, particularly if the clinical workup should have yielded a more specific diagnosis. Once a definitive etiology is identified (acute coronary syndrome, GERD, costochondritis, anxiety disorder), subsequent encounters should use the disease-specific code rather than the symptom code. For optimal reimbursement and reduced claim denials, documentation should clearly support why a more specific chest pain code (R07.1, R07.2, R07.89) or a definitive diagnosis code could not be assigned.

Frequently Asked Questions