The ICD-10-CM code for chest pain with no further detail is R07.9, Chest pain, unspecified, but the R07 family has six billable chest pain codes, and once the provider confirms a cause such as angina or a myocardial infarction, you code that condition instead of the symptom.
Chest pain is one of the most common reasons for emergency department, urgent care, observation and cardiology visits, which makes it one of the easiest places to lose accuracy. Coders often default to R07.9 even when the note says atypical, pleuritic or chest wall pain, or they code a suspected cardiac diagnosis that was never confirmed.
Both mistakes cause problems. Unspecified codes weaken medical necessity for tests such as an echocardiogram or stress test, while coding a “rule out” diagnosis as if it were confirmed misstates the patient’s record and can trigger audits.
This guide covers every R07 code in the FY2027 ICD-10-CM code set (in effect since 1 October 2026), how chest pain symptom codes differ from I20 angina and I21 myocardial infarction codes, the outpatient and inpatient rules for uncertain diagnoses, and worked ED and observation examples.
Key Takeaways
- R07 and R07.8 are category and subcategory headers and cannot be billed. The billable chest pain codes are R07.1, R07.2, R07.81, R07.82, R07.89 and R07.9.
- R07.89, Other chest pain, covers anterior chest-wall pain NOS and is the usual code for atypical, non-cardiac or chest wall pain.
- Pleuritic pain indexes to R07.81 (Pleurodynia), not R07.1. Epidemic pleurodynia (Bornholm disease) is excluded from R07 and coded B33.0.
- In outpatient settings, including ED and observation stays, do not code probable, suspected or rule-out diagnoses. Code the chest pain symptom instead.
- When the cause is confirmed, code the condition and drop the chest pain code, because the symptom is integral to it. For CAD with angina, use the I25.11- combination codes.
All Chest Pain ICD-10 Codes (R07) for FY2027
Category R07 is titled Pain in throat and chest. Only the codes marked billable can go on a claim. Titles below are the official ICD-10-CM titles.
| Code | Official title | Billable? | Typical documentation |
|---|---|---|---|
| R07 | Pain in throat and chest | No, category header | Never report alone |
| R07.0 | Pain in throat | Yes | Throat pain, not chest pain |
| R07.1 | Chest pain on breathing | Yes | Pain on breathing or painful respiration |
| R07.2 | Precordial pain | Yes | Pain documented as precordial |
| R07.8 | Other chest pain | No, subcategory | Needs a 5th character |
| R07.81 | Pleurodynia | Yes | Pleurodynia, pleuralgia, pleuritic pain |
| R07.82 | Intercostal pain | Yes | Pain documented as intercostal |
| R07.89 | Other chest pain | Yes | Anterior chest-wall pain NOS, atypical chest pain, chest tightness, non-cardiac chest pain |
| R07.9 | Chest pain, unspecified | Yes | Chest pain with no type or location |
Instructional notes that change the code
Excludes1 at R07. Epidemic myalgia, also called Bornholm disease or epidemic pleurodynia, is coded B33.0 and is never reported with an R07 code.
Excludes2 at R07. Jaw pain (R68.84) and pain in breast (N64.4, Mastodynia) are separate conditions. They can be reported with a chest pain code when both are documented.
Index direction for pleuritic pain. The Alphabetic Index sends pleuritic and pleural pain to R07.81, Pleurodynia. Use R07.1 only when the provider documents pain on breathing without calling it pleuritic.
How to Choose the Right R07 Code
Always start in the Alphabetic Index with the provider’s exact words, then confirm in the Tabular List. Our overview of how CPT, ICD-10 and HCPCS codes work together explains this two-step lookup.
| Provider documents | Code | Why |
|---|---|---|
| Chest pain | R07.9 | No type or site given |
| Atypical chest pain | R07.89 | Other chest pain; atypical is not a separate code |
| Chest wall pain | R07.89 | Anterior chest-wall pain NOS is an inclusion term |
| Chest tightness | R07.89 | Indexed to other chest pain |
| Pleuritic chest pain | R07.81 | Pleuritic pain indexes to pleurodynia |
| Pain worse on breathing | R07.1 | Chest pain on breathing |
| Precordial pain | R07.2 | Documented site is precordial |
| Intercostal pain | R07.82 | Documented site is intercostal |
If the note says both chest pain and shortness of breath, code both when neither is explained by a confirmed diagnosis. See our guide to the ICD-10 code for SOB (R06.02) for the breathing side of the encounter.
Symptom Code or Definitive Diagnosis? The Official Rules
The ICD-10-CM Official Guidelines for Coding and Reporting decide when a chest pain code belongs on the claim. The rules differ by setting.
Outpatient, ED and observation (Section IV). Do not code diagnoses documented as probable, suspected, questionable, rule out, compatible with or working diagnosis. Code to the highest degree of certainty, which is often the symptom. Observation stays follow these outpatient rules even though the patient is in a hospital bed.
Inpatient admissions (Section II.H). If a diagnosis is still documented as probable or suspected at discharge, code it as if it existed. This applies to inpatient admissions only.
Integral symptoms (Section I.B.5). Signs and symptoms routinely associated with a confirmed disease are not coded separately. Chest pain is integral to angina and acute MI, so R07.- is not added once those are confirmed.
Observation Z03 codes (Section I.C.21). Z03.89, Encounter for observation for other suspected diseases and conditions ruled out, is not used when the patient has a sign or symptom related to the suspected condition. A patient with chest pain gets the R07 code, not Z03.89.
Do not code a rule-out MI as I21. In an ED or observation claim, rule out ACS or possible NSTEMI is reported with the chest pain symptom code until the provider confirms the diagnosis.
Angina (I20) and MI (I21) vs Chest Pain Symptom Codes
R07 codes describe a symptom whose cause is not established. I20 and I21 codes describe confirmed cardiac diagnoses and need clear provider documentation. Several common I20 and I21 entries are headers, not billable codes.
| Code | Official title | Billable? |
|---|---|---|
| I20.0 | Unstable angina | Yes |
| I20.1 | Angina pectoris with documented spasm | Yes |
| I20.2 | Refractory angina pectoris | Yes |
| I20.8 | Other forms of angina pectoris | No, subcategory |
| I20.81 | Angina pectoris with coronary microvascular dysfunction | Yes |
| I20.89 | Other forms of angina pectoris | Yes |
| I20.9 | Angina pectoris, unspecified | Yes |
| I21.0, I21.1, I21.2 | STEMI of anterior wall, inferior wall, other sites | No, need a 5th character such as I21.02 or I21.11 |
| I21.4 | Non-ST elevation (NSTEMI) myocardial infarction | Yes |
| I21.A1 | Myocardial infarction type 2 | Yes |
CAD with angina: use the combination code
ICD-10-CM presumes a causal link between coronary atherosclerosis and angina. When both are documented, assign a combination code from I25.11-, such as I25.110, Atherosclerotic heart disease of native coronary artery with unstable angina pectoris, instead of I25.10 plus a separate I20 code. I25.10 is reserved for CAD without angina pectoris.
When an acute MI is the reason for the encounter in a patient with CAD, sequence the I21 code first. For procedure coding on the cardiac side, see our 93458 left heart catheterization billing guide.
Chest Pain Codes Often Confused With Other Conditions
| Code | Official title | Use instead of R07 when |
|---|---|---|
| M94.0 | Chondrocostal junction syndrome [Tietze] | The provider diagnoses Tietze syndrome or chondrocostal junction syndrome |
| M54.6 | Pain in thoracic spine | The pain is documented in the thoracic spine, not the chest; see our thoracic pain ICD-10 guide |
| K21.9 | Gastro-esophageal reflux disease without esophagitis | GERD is confirmed as the cause; see our gastric reflux ICD-10 guide |
| B33.0 | Epidemic myalgia | Bornholm disease or epidemic pleurodynia is documented |
| N64.4 | Mastodynia | The pain is in the breast |
| S20.211A | Contusion of right front wall of thorax, initial encounter | Chest wall pain follows trauma and an injury is documented |
For external chest pain after an injury, code the injury from Chapter 19 with the correct 7th character (A for active treatment) and add external cause codes as your payer requires. Use R07.89 only when chest wall pain has no documented injury or other cause. For animal-bite injuries, see our dog bite ICD-10 coding guide.
Worked Examples: ED, Observation and Inpatient
Example 1, ED visit. A 54-year-old presents with chest discomfort. EKG and serial troponins are normal. Final impression: atypical chest pain, rule out ACS, discharged with cardiology follow-up. Code R07.89. The rule-out diagnosis is not coded. The E/M level is chosen separately; see our CPT 99284 guide.
Example 2, observation stay. A patient is placed in observation for chest pain, likely GERD. Because observation follows outpatient rules, likely GERD is not coded. Report R07.9 unless the provider describes the type or site of the pain.
Example 3, confirmed NSTEMI. Troponin rises and the cardiologist documents NSTEMI. Code I21.4. Do not add R07.9, because chest pain is integral to the MI.
Example 4, inpatient admission. A patient with known CAD is admitted, and the discharge summary says probable unstable angina. Under Section II.H the uncertain diagnosis is coded as established, and the combination code I25.110 is assigned.
How to Code a Chest Pain Encounter Step by Step
- Identify the setting. Outpatient, ED and observation follow Section IV; inpatient admissions follow Section II.
- Read the final assessment. Code from the provider’s impression, not the chief complaint or triage note.
- Check for a confirmed cause. If one exists, code it and drop the integral chest pain symptom.
- Pick the most specific R07 code. Look up the documented words in the Index, then confirm Excludes notes in the Tabular List.
- Add unrelated symptoms. Code symptoms not explained by the final diagnosis, such as shortness of breath.
- Link the diagnosis to each test. Point the most supportive code to the EKG, imaging or echo line on the claim.
Chest Pain Coding and Claim Denials
Most chest pain denials come from the link between the diagnosis and the test. An echo or stress test billed with R07.9 alone may fail a payer’s medical necessity edit when the record actually supports a more specific code. Our 93306 echocardiogram billing guide covers echo documentation, and a diagnosis that does not support the procedure often returns as a CO-11 denial.
- Never bill the non-billable headers R07, R07.8, I20.8 or I21.0 to I21.2.
- Query the provider when the note says chest pain but the exam describes a specific site or quality.
- Recheck codes against the FY2027 set for dates of service on or after 1 October 2026.
- Review payer coverage policies for the tests you link to chest pain codes.
Cardiology groups with heavy chest pain volume can also see our cardiology billing services, and hospital-based groups our emergency room billing services.
Want chest pain, angina and MI coded to the highest certainty on every claim? Steady Medical Billing’s medical coding team review ED, observation and cardiology documentation against the current ICD-10-CM guidelines before claims go out.
Frequently Asked Questions
What is the ICD-10 code for chest pain?
R07.9, Chest pain, unspecified, is used when no type or site is documented. More specific codes are R07.1, R07.2, R07.81, R07.82 and R07.89. When a cause such as angina or MI is confirmed, code that condition instead.
What is the ICD-10 code for atypical chest pain?
Atypical chest pain is coded R07.89, Other chest pain. The same code covers anterior chest-wall pain NOS, chest tightness and non-cardiac chest pain when no cause is confirmed.
Is R07.8 a billable code?
No. R07.8 is a subcategory header. Report R07.81 Pleurodynia, R07.82 Intercostal pain or R07.89 Other chest pain instead.
Can I code chest pain with angina or MI?
Usually not. Chest pain is a symptom routinely associated with angina and acute MI, so once either is confirmed the R07 code is dropped. For CAD with angina, use an I25.11- combination code.
How do I code rule out MI in the ED or observation?
In outpatient settings, including ED and observation, do not code rule-out or probable diagnoses. Code the documented symptom, such as R07.9 or R07.89, until the provider confirms the diagnosis.
Is R07.4 a valid ICD-10 code for chest pain?
Only in the WHO version of ICD-10, where R07.4 means Chest pain, unspecified. The US ICD-10-CM has no R07.4, so a US claim with R07.4 will be rejected. Use R07.9 for unspecified chest pain, or a more specific R07 code if one is documented.
