Pain management practices adopting ICD-10 should be very cautious about the use of category G89 codes as they are used in specific conditions. Typically, these codes may be used in conjunction with codes from other categories and chapters in order to provide more detail about acute or chronic pain and neoplasm related pain. You should not assign a code from this category if the pain is not specified as acute or chronic, neoplasm related, postthoracotomy or postprocedural. Let’s take a look at the codes from this category and their proper use.
Category G89 Codes for Different Types of Pain
- G89.11: Acute pain due to trauma
- G89.21: Chronic pain due to trauma
- G89.12: Acute postthoracotomy
- G89.18: Other acute postprocedural pain
- G89.22: Chronic post thoracotomy pain
- G89.28: Other chronic postprocedural pain
Routine or expected postoperative pain that developed instantly after surgery should not be coded. While postoperative pain not associated with a specific postoperative complication should be assigned the relevant postoperative G89 pain code, the postoperative pain associated with a specific postoperative complication should be assigned the code found in Chapter 19, Injury, poisoning, and certain other consequences of external causes. You can use additional code(s) from category G89 to report acute or chronic pain, if it is appropriate.
- G89.3: Neoplasm related pain (acute) (chronic)
This code is used to indicate the pain reported as being related, associated or due to cancer, primary or secondary malignancy or tumor and is assigned regardless of whether it is acute or chronic.
- G89.0: Central pain syndrome
- G89.4: Chronic pain syndrome
If central pain syndrome indicates a neurological condition that results from damage to or dysfunction of the central nervous system, chronic pain syndrome indicates chronic pain associated with a significant psychosocial dysfunction (for example, depression, drug dependence). Chronic pain syndrome is different from chronic pain and this neurological condition should be coded only when the physician specifically documents it.
The other code in category G89 is G89.29 for other chronic pain.
Using G89 Codes for Principal Diagnosis
If a patient admission or encounter is for a procedure to treat the underlying condition instead of pain control or management, the underlying condition should be reported as the principal diagnosis as per ICD-10-CM guidelines while any code from category G89 should not be assigned. The codes from category G89 are used under the following conditions:
- The reason for the admission/encounter should be pain control or pain management. The underlying cause of the pain, if known, should be reported.
- If the admission or encounter is for the insertion of a neurostimulator for pain control, the appropriate pain code should be assigned as the principal diagnosis. If the admission or encounter is for a procedure to treat the underlying condition and a neurostimulator is inserted for pain control at the time of the same admission/encounter, then the code for the underlying condition should be assigned as the principal diagnosis, while the pain code should be assigned as secondary diagnosis.
For example, if a patient is admitted for acute lower back pain due to trauma from sports injury and the reason for admission is pain management, G89.11 (Acute pain due to trauma) is assigned as principal diagnosis.
Using G89 Codes with Site Specific Pain Codes
A code from category G89 may be used in conjunction with the codes that indicate the specific site of the pain when that category G89 code provides additional information (for example, the code indicates the specific site, but not specifies whether an acute or chronic pain). The sequencing of these two types of codes depends upon the circumstances of the encounter or admission and it is described as follows:
- If the encounter or admission is for either pain control or pain management, assign the code from category G89 first, followed by the code that indicates the specific site of pain.
- If the encounter or admission is for anything except pain control/management and the provider has not established a related definitive diagnosis yet, assign the code for specific site first, followed by the relevant code from category G89.