Pain is a common complaint that physicians of all specialties treat. However, assessment of patients is a challenge as it depends upon self-report measures that, though valid, cannot convey the complexity of the pain experience. Likewise, correct code assignment on claims is also a challenge as there are extensive ICD-10 guidelines on how different types of pain should be reported and the code sequencing process. Partnering with a pain management medical billing company can ensure accurate coding and efficient claims management for optimal reimbursement.
Types of Pain
Pain can have an obvious cause like an injury or illness or occur by itself. Knowing the specific terminology for different types of pain is essential to assign the right code.
- Acute vs chronic: Providers may document pain as acute or chronic. .Acute pain is that which lasts from minutes to about three months. Chronic pain lasts for a longer time and maybe constant or recur frequently. Chronic pain is often due to a health condition, like arthritis, fibromyalgia, or a spine condition.
- Traumatic: This refers to pain caused by traumatic injuries such as an accident or fracture.
- Postoperative: This is the occurrence of pain after operation, which can occur in the joints and muscles, and head and limbs.
- Site specific: ICD-10 requires capturing anatomic Site specific pain relates to that in a specific anatomic region such as the arm, shoulder, etc).
- Pain is a symptom of a confirmed diagnosis: Examples of pain associated with a confirmed diagnosis include pain due to ankylosing spondylitis (AS) and abdominal pain due to Signs and symptoms with a confirmed diagnosis should not be reported if the signs or symptom are integral to the diagnosis.
ICD-10 Pain Codes
ICD-10 has more than 162 codes for reporting pain. The ICD-10-CM Official Guidelines for Coding and Reporting include extensive notes and instructions for coding pain. Pain codes are found in many ICD-10 chapters such as Chapter 6 (G00-G99 – Diseases of the Nervous System), Chapter 7 (H00-H59 – Diseases of the Eye & Adnexa), Chapter 13 (M00-M99 Diseases of the Musculoskeletal System and Connective Tissue), and Chapter 19 (S00-T88 – Injury, Poisoning, and Certain Other Consequences of External Causes).
The commonly used ICD-10 pain codes are:
G89.0 Central pain syndrome Chronic Condition
G89.11‑G89.18 G89.1 Acute pain, not elsewhere classified
G89.21‑G89.29 G89.2 Chronic pain, not elsewhere classified
G89.3 Neoplasm related pain (acute) (chronic)Chronic Condition
G89.4 Chronic pain syndrome
Reporting ICD-10 Pain Codes – Key Points
- Sequencing pain codes
ICD-10 pain codes are assigned and sequenced based on the encounter notes and the reason for the admission/encounter. When pain is the primary diagnosis, codes from the G89 category can be sequenced first.
- When the reason for the visit/service is specifically for pain management or pain control, the code(s) from the G89 category describing the patient’s pain should be assigned and listed first. In this situation, the provider is treating the pain and not the condition causing it.
- Codes from category G89 should not be reported as the first-listed diagnosis if the underlying (definitive) diagnosis (g., spinal fusion, kyphoplasty) is known and the reason for the service is to manage/treat the underlying condition.
Here are two examples from AAPC:
- If the reason for the visit is pain management for acute neck pain from trauma, report G89.11 Acute pain due to traumafollowed by M54.2 Cervicalgia
- Report neoplasm related pain (acute) (chronic)(G89.3) as the first-listed diagnosis when the encounter is for pain control. Neoplasm should be reported as an additional code.
- Site-specific pain codes
Correctly identify the site and/or source of the pain. Codes from the G89 category may be reported in conjunction with codes that identify the site of pain to provide additional information about the type of pain. For example, both codes should be assigned if the code describes the site of the pain, but does not fully explain if the pain is acute or chronic.
- Chronic pain
The ICD official guidelines state: “There is no time frame defining when pain becomes chronic pain. The provider’s documentation should be used to guide use of these codes” (Section I.C.6.b.4). So when the provider documents pain as chronic, it should be reported as chronic.
- Postoperative pain
ICD-10 guidelines state “routine or expected postoperative pain immediately after surgery&rdquo should not be coded. Postoperative pain that is documented as associated with a specific postoperative complication should be reported with the right postoperative pain code from category G89, Pain not elsewhere classified. There are 4 post-operative pain codes:
G89.12 Acute post-thoracotomy pain
G89.18 Other acute post-procedural pain
G89.22 Chronic post-thoracotomy pain
G89.28 Other chronic post-procedural pain
Acute or chronic pain can occur due to various post-operative complications, for e.g. postoperative infection, foreign body accidentally left in the body following a procedure, and complications of implants, grafts, and prosthetic devices. The coder should review the medical record to determine if there is a cause-and-effect relationship the complication and the pain.
If the documentation states that the postoperative pain is due to a complication of the procedure, the primary diagnosis is the complication. A code from category G89 can be assigned as a secondary diagnosis, if appropriate, to indicate if the pain is acute or chronic.
- Neoplasm related pain
Pain can occur due to a neoplastic process such as a tumor compressing or infiltrating tissue, from treatments and diagnostic procedures, or from skin, nerve, and other changes caused by a hormone imbalance or immune response. If the reason for the encounter is to control the neoplasm-related pain, G89 should be assigned as the principal code with the specific neoplasm code as the secondary diagnosis.
Careful Documentation is Key to Correct Coding
It is up to the clinician is to accurately document the nature of patient’s medical condition and the services performed to address that condition. This is important for the coding team in a pain management billing company to assign the correct codes consistent with the documentation. While there are separate ICD-10 codes for pain due to trauma, post-thoracotomy pain, other post procedural pain, and other pain, there is no specific timeframe identifying when the pain becomes chronic. The provider’s documentation should be used to guide code assignment.