R11.2: Nausea with vomiting, unspecified

The ICD-10-CM code for nausea with vomiting when the provider records both symptoms and no established diagnosis explains them at this encounter.

Billable

FY2027

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At a glance

Code Family

R11: Nausea and vomiting.

DRG Grouping

MS-DRG 391 or 392, Esophagitis, gastroenteritis and miscellaneous digestive disorders, when R11.2 is the principal diagnosis under the FY2027 MS-DRG v44 grouper.

HCC Mapping (v28)

None. R11.2 does not map to a payment HCC in the CMS-HCC v28 crosswalk.

Family Specificity

Nine billable codes sit in R11, split by whether nausea, vomiting or both are documented and by the type of vomiting.

Billable

Yes. R11.2 is a complete code in the FY2027 billable code list.

Effective Date

Valid in the FY2026 code set and unchanged in the FY2027 update.

Which R11 code do I assign?

Category R11 splits first on whether the provider documents nausea, vomiting or both. Within vomiting, subcategory R11.1 splits further by the type the note names, from projectile vomiting to cannabis hyperemesis syndrome.

When documentation says…

Code

Nausea and vomiting, cause not yet determined

R11.2

Nausea with vomiting, unspecified. The Index sends Nausea, with vomiting and Vomiting, with nausea here. Persistent nausea with vomiting NOS is an inclusion term at R11.2.

Nausea without vomiting

R11.0

Nausea. The Index main term Nausea (without vomiting) defaults here. Nausea NOS and nausea without vomiting are inclusion terms at R11.0.

Vomiting, nausea not mentioned

R11.10

Vomiting, unspecified. The Index main term Vomiting defaults here. When the provider states vomiting without nausea, the Index sends it to R11.11 instead.

Persistent vomiting or cyclic vomiting syndrome

R11.15

Cyclical vomiting syndrome unrelated to migraine. Persistent vomiting and cyclic vomiting syndrome NOS are inclusion terms here. Cyclical vomiting in migraine indexes to G43.A0 or G43.A1, which the R11 Excludes1 note bars.

Cannabis hyperemesis syndrome

R11.16

Cannabis hyperemesis syndrome. The Index sends Syndrome, cannabis hyperemesis and Syndrome, cannabinoid hyperemesis here. Its code also note points to the cannabis use code and manifestations such as dehydration (E86.0).

Vomiting in pregnancy or hyperemesis gravidarum

O21.9

Vomiting of pregnancy, unspecified. The Index sends Pregnancy, complicated by, vomiting here. Hyperemesis gravidarum indexes to O21.0, or to O21.1 with dehydration, electrolyte imbalance or metabolic disturbance.

Nausea and vomiting from chemotherapy

R11.2

Nausea with vomiting as the nature of an adverse effect. Guideline I.C.19.e.5.(a) sequences it first, followed by a T45.1X5 code for the antineoplastic drug. The note must link the symptoms to the drug.

Tabular notes

EXCLUDES1

Category R11 carries an Excludes1 note for cyclical vomiting associated with migraine (G43.A-), excessive vomiting in pregnancy (O21.-), hematemesis (K92.0), neonatal hematemesis (P54.0), newborn vomiting (P92.0-), psychogenic vomiting (F50.89), vomiting associated with bulimia nervosa (F50.2-) and vomiting following gastrointestinal surgery (K91.0).

None of these is reported together with R11.2 for the same condition. R11.2 carries no Excludes1 note of its own.

EXCLUDES2

Block R10-R19 carries an Excludes2 note for congenital or infantile pylorospasm (Q40.0), gastrointestinal hemorrhage (K92.0-K92.2), intestinal obstruction (K56.-), newborn gastrointestinal hemorrhage (P54.0-P54.3), newborn intestinal obstruction (P76.-), pylorospasm (K31.3), signs and symptoms involving the urinary system (R30-R39), symptoms referable to female genital organs (the N94 codes) and symptoms referable to male genital organs (N48-N50).

For hematemesis (K92.0), the R11 Excludes1 note still bars the pairing for the same condition.

Chapter 18 carries an Excludes2 note for abnormal findings on antenatal screening of mother (O28.-), certain conditions originating in the perinatal period (P04-P96), signs and symptoms classified in the body system chapters and signs and symptoms of breast (N63, N64.5).

R11.2 and R11 carry no Excludes2 note of their own.

CODE ALSO

R11.2 carries no code also, use additional code or code first instruction. None sits above it at R11, the R10-R19 block or Chapter 18.

Its sibling R11.16 carries a code also note for cannabis abuse (F12.1-), cannabis dependence (F12.2-), cannabis use, unspecified (F12.92-, F12.93, F12.95-, F12.98-, F12.99) and manifestations such as dehydration (E86.0) and electrolyte imbalance (E87.8).

FY2027: EFFECTIVE 1 OCTOBER 2026

The FY2027 codes addenda make no addition, deletion or revision in category R11. R11.2 is in the FY2027 billable code list and is unchanged in the FY2027 update.

The FY2027 tabular addenda correct a typographical error in the R11.16 code also note. The electrolyte imbalance entry now closes with a parenthesis after E87.8 instead of a brace.

No other FY2027 change to the R11 instructional notes was identified.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

R11.2, R11.0 and R11.10 do not map to a payment HCC in the CMS-HCC v28 diagnosis crosswalk.

R11.15 was already valid in FY2021, per the CMS MS-DRG Definitions Manual v38.0. Its absence from the bundled FY2022 to FY2023 crosswalk file means it maps to no payment HCC. R11.16 first appears in FY2026, after that file, and its v28 mapping is indeterminate.

In the same crosswalk, F12.20, Cannabis dependence, uncomplicated, maps to HCC 137: Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications.

MS-DRG v44 (FY2027)

MS-DRG 391: Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC.

MS-DRG 392: Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC.

R11.2 as principal diagnosis groups to one of these two DRGs in MDC 06, per the CMS MS-DRG v44.0 Definitions Manual, Appendix B.

WHERE SPECIFICITY IS LOST

Reporting R11.2 as principal diagnosis once a related definitive diagnosis is established conflicts with Section II.A of the Official Guidelines.

Reporting R11.2 for vomiting in pregnancy, cyclical vomiting in migraine, hematemesis or vomiting after gastrointestinal surgery conflicts with the R11 Excludes1 note.

Reporting R11.2 for a diagnosed cannabis hyperemesis syndrome loses R11.16 and the cannabis use code its code also note points to.

Reporting R11.2 alone for drug-induced nausea and vomiting omits the T36-T50 adverse effect code that Guideline I.C.19.e.5.(a) calls for.

SEVERITY DESIGNATION (MS-DRG V44, FY2027)

R11.2 is on neither list. It carries no CC or MCC designation as a secondary diagnosis.

No code in category R11 carries a CC or MCC designation.

Per Table 6I (Complete MCC List) and Table 6J (Complete CC List) of the FY2027 IPPS final rule (CMS-1849-F), MS-DRG v44.

Documentation checklist to support R11.2

Chart elements that support code selection and reduce specificity-driven denials.

The symptoms in the provider's own words. Nausea with vomiting indexes to R11.2, nausea alone to R11.0 and vomiting alone to R11.10.

A statement that no definitive diagnosis accounts for the symptoms at this encounter, or that the workup is still pending.

Pregnancy status. Vomiting in pregnancy is coded in category O21, which the R11 Excludes1 note bars from R11.

Cannabis use and the provider's diagnosis when cannabis hyperemesis syndrome is suspected, which moves the code to R11.16 with its code also instruction.

Any link to migraine when the vomiting is cyclical. Cyclical vomiting in migraine is coded in subcategory G43.A rather than R11.15.

Blood in the vomitus or recent gastrointestinal surgery. Hematemesis is K92.0 and vomiting following gastrointestinal surgery is K91.0.

The drug and the provider's link to it when the symptoms are an adverse effect of a correctly administered medication, which adds a T36-T50 code (Guideline I.C.19.e.5.(a)).

For outpatient encounters, the symptoms rather than a probable, suspected or rule out diagnosis (Section IV.H).

For inpatient stays, the discharge statement of the established or uncertain diagnosis, which decides whether R11.2 remains reportable (Sections II.A and II.H).

FAQ

Is R11.2 a billable code?

Yes. R11.2 is a complete code with no further characters. It appears in the FY2027 billable code list. Its parent R11 is a category and cannot be reported.

What is the difference between R11.2, R11.0 and R11.10?

The difference is which symptoms the provider documents. The Alphabetic Index sends Nausea, with vomiting and Vomiting, with nausea to R11.2. It sends Nausea without a qualifier to R11.0 and Vomiting without a qualifier to R11.10. When both symptoms are documented, the Index route is R11.2.

Does R11.2 map to an HCC under CMS-HCC v28?

No. R11.2 does not appear in the CMS-HCC v28 diagnosis crosswalk. R11.0 and R11.10 do not appear either. R11.15 was valid by FY2021, per the CMS MS-DRG Definitions Manual v38.0, and is absent from the bundled FY2022 to FY2023 crosswalk file. It maps to no payment HCC. R11.16 first appears in FY2026, after that file, and its v28 mapping is indeterminate.

How is nausea and vomiting in pregnancy coded?

With a code from category O21, not R11.2. The R11 Excludes1 note bars excessive vomiting in pregnancy (O21.-) from R11. The Index sends Pregnancy, complicated by, vomiting to O21.9 and hyperemesis gravidarum to O21.0. Hyperemesis gravidarum with dehydration, electrolyte imbalance or metabolic disturbance goes to O21.1. Chapter 15 codes have sequencing priority over codes from other chapters (Guideline I.C.15.a.1).

How are cannabis hyperemesis syndrome and cyclic vomiting syndrome coded?

Each has its own code in subcategory R11.1. The Index sends cannabis and cannabinoid hyperemesis syndrome to R11.16. Its code also note points to cannabis abuse (F12.1-), cannabis dependence (F12.2-), unspecified cannabis use and manifestations such as dehydration (E86.0). Cyclic vomiting syndrome NOS and persistent vomiting are inclusion terms at R11.15. Cyclical vomiting in migraine goes to G43.A0 or G43.A1 instead.

How is chemotherapy-induced nausea and vomiting coded?

Guideline I.C.19.e.5.(a) names vomiting as an example of the nature of an adverse effect of a drug correctly prescribed and properly administered. Assign R11.2 first, followed by the T45.1X5 code for the antineoplastic drug with its seventh character. When a patient admitted for chemotherapy develops uncontrolled nausea and vomiting, Z51.11 is the principal or first-listed diagnosis, followed by the complication codes (Guideline I.C.2.e.3).

How is R11.2 sequenced in inpatient and outpatient settings?

In the outpatient setting, R11.2 is reported when nausea and vomiting are the reason for the visit and no diagnosis has been established (Section IV.D). A probable, suspected or rule out diagnosis is not coded there (Section IV.H). In the inpatient setting, a Chapter 18 symptom code is not used as principal diagnosis once a related definitive diagnosis is established (Section II.A). An uncertain diagnosis documented at discharge is coded as if it existed (Section II.H).

What changed for R11.2 in FY2027?

Nothing for R11.2. The FY2027 codes addenda make no addition, deletion or revision in category R11. The FY2027 tabular addenda correct a typographical error in the R11.16 code also note, closing the E87.8 entry with a parenthesis instead of a brace. R11.16 itself first appeared on 1 October 2025, in FY2026, per the CMS MS-DRG Definitions Manuals, v42.0 (FY2025) and v43.0 (FY2026).

Related codes

Codes in the same family as R11.2. Only codes with a published page render as links.

Sibling codes in the R11 family

R11.0: Nausea, when nausea is documented without vomiting.
R11.10: Vomiting, unspecified, when vomiting is documented with no further detail.
R11.11: Vomiting without nausea, when the provider states that no nausea accompanied the vomiting.
R11.12: Projectile vomiting, when the vomiting is documented as projectile.
R11.13: Vomiting of fecal matter, when fecal vomiting is documented.
R11.14: Bilious vomiting, when bilious vomiting or bilious emesis is documented.
R11.15: Cyclical vomiting syndrome unrelated to migraine, for cyclic vomiting syndrome NOS or persistent vomiting.
R11.16: Cannabis hyperemesis syndrome, when the provider diagnoses cannabis or cannabinoid hyperemesis syndrome.

Additional codes to consider

Codes outside the R11 family considered alongside R11.2.

Companion: code alongside when documented

T45.1X5A: Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter, when the provider links the symptoms to chemotherapy (Guideline I.C.19.e.5.(a)).
Z51.11: Encounter for antineoplastic chemotherapy, sequenced first when uncontrolled nausea and vomiting develop during a chemotherapy admission (Guideline I.C.2.e.3).

Consider instead

O21.9: Vomiting of pregnancy, unspecified, when vomiting complicates a pregnancy.
O21.0: Mild hyperemesis gravidarum, when hyperemesis gravidarum is documented without metabolic disturbance.
O21.1: Hyperemesis gravidarum with metabolic disturbance, when dehydration, electrolyte imbalance or carbohydrate depletion is documented.
O21.2: Late vomiting of pregnancy, when the vomiting occurs after 20 weeks of gestation.
G43.A0: Cyclical vomiting, in migraine, not intractable, when the provider links cyclical vomiting to migraine.
G43.A1: Cyclical vomiting, in migraine, intractable, when that cyclical vomiting is documented as intractable.
K92.0: Hematemesis, when blood is documented in the vomitus.
K91.0: Vomiting following gastrointestinal surgery, when the vomiting follows gastrointestinal surgery.
F50.89: Other specified eating disorder, when the provider documents psychogenic vomiting.
K31.89: Other diseases of stomach and duodenum, when the provider documents functional vomiting.
P92.09: Other vomiting of newborn, when the patient is a newborn.
T75.3XXA: Motion sickness, initial encounter, when nausea is documented as seasickness or motion sickness.
A08.4: Viral intestinal infection, unspecified, when the provider diagnoses viral gastroenteritis as the cause.
K52.9: Noninfective gastroenteritis and colitis, unspecified, when the provider diagnoses gastroenteritis without a stated infectious cause.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software