Pain Management Reporting in ICD-10-CMSeptember 30, 2021
The diagnosis and the determination of an appropriate treatment plan are vital. To ensure total accuracy in pain management coding, here’s a full guide to the ICD-10 classification of pain, as well as the rules of sequencing pain codes.
Categories of Pain Codes
- Pain in which a particular body system is affected is under the body system chapters like low back pain and testicular pain. Low back pain belongs to the Musculoskeletal section (M54.5). The ICD-10 code for pain M54.5 will be a non-billable code and will be replaced with the following three code options:
- M54.50 Low back pain, unspecified
- M54.51 Vertebrogenic low back pain
- M54.59 Other low back pain
Meanwhile, testicular pain belongs to Other and unspecified disorders of male genital organs (N50.81). Diagnosis Code N50.81 is not appropriate for reimbursement purposes as multiple codes below contain more detail.
- Pain that does not indicate a specific body system is under Symptoms and Signs. Abdominal pain is under (category R10.9). R10.9 is a billing/specific ICD-10-CM code that suggests a diagnosis for reimbursement purposes.
- Distinct sets of pain are under category G89 (Pain, not elsewhere classified) in the Nervous System section.
Read on more to know the three types of pain codes. Always make sure that the physician’s documentation aligns with the patient’s diagnosis. Refer to the ICD-10-CM Index and follow whatever instructions it provides.
In category R10 of ICD-10-CM, over 30 different codes describe various types of abdominal and pelvic pain. Pain codes in other parts of the abdomen are as follows:
- Pain code for acute abdominal pain category (R10.0). It is a diagnosis code for acute abdominal pain that is severe, localized, and rapid-onset. Many disorders, conditions, and diseases may result in acute abdominal pain. If you have this type of pain, it can be a condition that requires surgery. For example, a medical condition that is peritonitis or acute appendicitis.
- Abdominal tenderness pain code (R10.81-). Tenderness also means being “sensitive to pain.” During an examination of the abdomen, a physician may know if the patient experiences abdominal tenderness.
- Rebound abdominal tenderness pain code (R10.82-): When the examiner presses on the abdomen, “tenderness” discomfort may occur. A rebound tenderness can also occur when the examiner releases the pressure. Thus, peritonitis may be the cause.
- Colic pain code (R10.83): Colic pain refers to the discomfort from smooth muscle contractions in the intestine or ureter.
- The “Pain, flank” entry in the ICD-10-CM Index shows a note to “see Pain, abdominal.” If the physician does not provide additional information about the location of abdominal pain (lower part or upper), you must code flank pain as unspecified abdominal pain (R10.9).
- The code for pelvic and perineal pain is (R10.2). Patients male and female can use this code for pelvic pain. Perineal pain occurs between the anus and the scrotum in men while anus and vulva in women.
The pain code for angina (I20.9) refers to “ischemic” chest pains. The codes for other types of chest pain are under category (R07) (Chest and throat pain). Post-thoracotomy pain, however, is an exception.
Code types for chest pain ICD-10-CM:
- Chest pain on breathing (R07.1)
- Precordial pain (R07.2)
- Pleurodynia (R07.81)
- Intercostal pain (R07.82)
- Other chest pain (R07.89)
Pain for Unspecified Site
- There are times the radiology department will receive a request that states “Pain” without a specific pain location. The ordering physician should provide a complete clinical history of flank pain, knee joint pains, or precordial pain. Otherwise, poor-quality documentation can be a big problem.
- According to the AHA Central Office, if the request doesn’t specify where the pain occurs, the code for pain at the imaging site is acceptable. Whenever the clinical history for a hand x-ray says, “Pain,” you should code it as “hand pain.” ICD-9-CM was the focus of this guidance, not ICD-10-CM.
- R52 is the code for pain NOS as per the ICD-10-CM Index. This type of code is vague, and reimbursement may have issues. When possible, seek a more precise diagnosis.
- R51.9 is the code for Headache, Unspecified. Other international versions of Headache ICD-10 R51.9 may differ from the American ICD-10-CM version R51.9.
The category G89 consists of codes for acute and chronic pains, neoplasm-related pains, and two pain syndromes. The physician or doctor must document that the pain is acute, chronic, or neoplasm-related to assign these codes.
If you know the cause of pain, don’t use the pain code for it. The ICD-10-CM guidelines require you to assign a code for the underlying diagnosis. In contrast, if the objective of the encounter is to manage the pain instead of the underlying condition, then first assign and sequence a pain code.
- One example is an interventional radiologist who performs a facet joint injection on a patient. The patient has chronic low back pain due to degenerative disc disease (DDD) of the thoracic spine with radiculopathy. Due to the nature of this encounter, you should code for the pain first, not the DDD evaluation or treatment. It has a primary diagnosis of G89.29 (Other chronic pain) and a secondary diagnosis of M51.14 (Thoracic intervertebral disc disorders with radiculopathy).
Meanwhile, pain diagnosis codes from category G89 are only valid for reporting as a primary diagnosis when:
- If the chronic pain or acute and neoplasm-related codes provide additional detail from other categories.
- If the cause of the service is for pain management or pain control.
Furthermore, it is not advisable to report a code from category G89 as a first-listed diagnosis if you know the underlying (definitive) diagnosis and the purpose of the service is to manage or treat that condition. You may report the acute/chronic pain code (G89) as a secondary diagnosis if the diagnosis provides additional, relevant information not adequately explained by the primary diagnosis code. Also, if the primary diagnosis codes lack additional and relevant information, you can report chronic pain/acute code (G89) as a secondary diagnosis.
If the patient has a document that has a more comprehensive diagnosis (acute/chronic pain), but the purpose of the visit/service is pain management or pain control, then it is best to report a diagnosis code from category G89 as the primary ICD-10-CM code.
Additionally, the ICD-10-CM guidelines recommend assigning G89 codes and codes from other categories or chapters to provide more specific information about acute/chronic pain and neoplasm-related pain. Using the G89 code, you can indicate whether the pain is acute or chronic. First, assign the site-specific pain code unless the visit is for pain management, in which case assign the G89 code.
Acute and chronic post-thoracotomy pain (G89.12, G89.22) and other postprocedural pain (G89.18, G89.28) are from the category G89. In the ICD-10-CM, there’s a coding restriction into “routine or expected postoperative pain immediately after a surgery.” The physician must also document that the patient’s pain is a complication of the surgery before assigning these codes.
In a case where a patient experiences pain with a specific postoperative complication (painful wire sutures), the difficulty may be on the primary diagnosis. If necessary, you can assign a code from category G89 as a secondary diagnosis to indicate whether the pain is acute or chronic.
Whenever a benign or malignant tumor produces pain anywhere on the body, use diagnosis code G89.3 to report. The coding is separate from other categories. In cases involving pain management, the pain code should be first on the list. Otherwise, the primary diagnosis will be for neoplasm. There is no need to assign a site-specific pain code with G89.3, according to ICD-10-CM guidelines.
What is the difference between these two codes for pain syndrome?
According to the National Institute of Neurological Disorders and Stroke (NINDS), central pain syndrome is a neurological condition characterized by damage or dysfunction of the central nervous system (CNS), including the brain, brainstem, and spinal cord. The condition may result in stroke, multiple sclerosis, neoplasm, epilepsy, CNS trauma, or Parkinson’s disease. The ICD-10-CM code for central pain syndrome is G89.0.
The ICD-10-CM code for chronic pain syndrome is G89.4. Take note that Chronic pain syndrome is not similar to chronic pain. A study says that chronic pain syndrome is a chronic pain that relates to psychosocial dysfunction. Depression, anxiety, or even drug dependence are psychosocial problems. Before coding this condition, make sure that the physician documents it accurately.
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