generalized abdominal pain associated with acute abdomen (R10.0) generalized abdominal pain NOS (R10.84)localized abdominal pain (R10.1-R10.4-)
R10.8A- Flank tenderness R10.8A1 Right flank tenderness R10.8A2 Left flank tenderness R10.8A3 Suprapubic tenderness R10.8A9 Flank tenderness, unspecified Flank tenderness NOS
R10.A- Pain localized to flank Lateral abdomen pain Lateral flank pain Latus region pain
Excludes2: pain localized to other parts of lower abdomen (R10.3-) pain localized to upper abdomen (R10.1-)
R10.A0 Flank pain, unspecified side R10.A1 Flank pain, right side R10.A2 Flank pain, left side R10.A3 Flank pain, bilateral
Socioeconomic Circumstance Codes
Chapter 21 includes codes that start with “Z”, and they represent reasons for encounters and factors influencing health status. The section of codes from Z55-Z65 are for “Persons with potential health hazards related to socioeconomic and psychosocial circumstances.” These codes can be used to report “social determinants of health”, which can be a factor that may indicate a moderate level of risk of morbidity, one element of medical decision making in support of a level 4 evaluation and management code. Reporting this additional detail on the claim form may reduce the need for payers to request records.
Inclusion terms, as defined in the ICD-10 guidelines, “may be synonyms of the code title” or “a list of the various conditions assigned to that code”. There are some new codes in the socioeconomic section of chapter 21, and some existing codes that got new inclusion terms, which are depicted below, in bold.
Z56.6 Other physical and mental strain related to work Workplace stress
Z56.89 Other problems related to employment Furloughed Underemployed
• Excludes1 – The new code R10.85 Abdominal pain of multiple sites has several listings under the Excludes1. This means that it can’t be used if those other codes are, and vice versa. They are mutually exclusive.
• Excludes2 – The new code Z59.861 Financial insecurity, difficulty paying for utilities has one code listed under Excludes2. This indicates that Z59.12 inadequate housing utilities is not included in Z59.861 and could be coded in addition.
• NOS – this abbreviation, found in many code descriptions, means “not otherwise specified”, and is synonymous with “unspecified”. It indicates that the code was chosen because the documentation does not specify detail enough to choose one of the other, more specific, codes. In many cases, unspecified codes should be a last resort, as it could indicate that the documentation is lacking.
• If you do not yet use diagnosis pointing when filling out box 24E on the CMS-1500 claim form, you might be getting denials that are easily avoidable.
There were many other changes to the code set for 2026, but these are the ones most likely to be relevant to chiropractors and physical medicine providers. To see the complete list of changes, go to
CMS.gov.
Z59.02 Unsheltered homelessness Lives in a homeless encampment
Z59.19 Other inadequate housing Poor housing weatherization
Z59.86 Financial insecurity Z59.861 Financial insecurity, difficulty paying for utilities Difficulty paying for electricity Difficulty paying for heat Difficulty paying for oil Difficulty paying water bill
Utility disconnect notice due to inability to pay Excludes2: inadequate housing utilities (Z59.12)
Z59.868 Other specified financial insecurity Bankruptcy
Z59.869 Financial insecurity, unspecified
Keep in mind that there are many other Z codes that include other details that may be helpful to report along with a condition. These are just some of the changes for 2026.
ICD-10 Tips
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