ICD-10-CM Reporting Pain
Coders will need to be ready to assign the appropriate codes for reporting different types of pain in different encounters, once ICD-10 is implemented on October 1st.
Types of Pain Codes :
Pain codes can be found in three different places in the ICD-10-CM manual:
- Pain which is caused due to the disorder of a specific body system is classified in the body system chapter. Like, low back pain is classified in the Musculoskeletal chapter (M54.5) and testicular pain is classified in the Genitourinary System chapter (N50.8).
- Pain that is not caused to a specific body system is found in the Symptoms and Signs chapter. Abdominal pain is classified to category R10.
- In the Nervous System chapter, specific type of pain is classified to category G89 (Pain, not elsewhere classified). There are many guidelines which can be related to this category in ICD‐10‐CM. To provide more detail about acute or chronic pain and neoplasm‐related pain, unless otherwise indicated in other guidelines, General Coding Guidelines Codes in category G89 may be used in conjunction with codes from other categories and chapters. A code from category G89 should not be assigned ,if the pain is not specified as acute or chronic, post‐thoracotomy , postprocedural, or neoplasm‐related,.
Pain of Unspecified Site
Documentation which states “Pain” without specifying the location of the pain constitutes poor documentation and should provide more details about the location of the pain or is it an acute or chronic pain.
In ICD-9-CM ,it is acceptable to assign the code for pain, even if it does not indicate the location of the pain. For example, if pain is mentioned in the clinical history for a hand x-ray, it is appropriate to code hand pain. However, this coding only applies for ICD-9-CM and not ICD-10-CM.
The ICD-10-CM Index indicates that pain NOS is reported with code R52 (Pain, unspecified). However, getting the reimbursement for this code can be difficult, so better to have a more specific diagnosis.
For various types of abdominal and pelvic pain, ICD-10-CM contains over 30 different codes in category R10. There are other codes also,in addition to the codes for pain in the various parts of the abdomen such as:
- Acute abdomen R10.0
- Abdominal tenderness R10.81
- Rebound abdominal tenderness R10.82
- Colic R10.83
In the ICD-10-CM Index, flank pain is directed to abdominal pain. Abdominal pain (R10.9) will be coded as flank pain unless there is additional information about the location of the pain, like upper or lower portion of the abdomen.
Code R10.2 is coded for Pelvic pain. This code applies to both male and female patients. It also includes perineal pain.
ICD-10-CM contains codes for the following types of chest pain:
- Chest pain on breathing (R07.1)
- Precordial pain (R07.2)
- Pleurodynia (R07.81)
- Intercostal pain (R07.82)
- Other chest pain (R07.89)
Category G89 includes codes for acute pain, chronic pain, and neoplasm-related pain, as well as codes for two pain syndromes. The documentation should mention whether the pain is acute, chronic, or neoplasm-related to assign these codes.
If the cause of the pain is known, a code for the underlying diagnosis should be coded and not the pain code, according to the ICD-10-GUIDELINES. However, ass the pain code can be assigned as the principal diagnosis if the purpose of the encounter is to manage the pain rather than the underlying condition.
G89 codes can be coded in conjunction with codes from other categories and chapters to provide more detail about acute or chronic pain or neoplasm-related pain,according to ICD-10-GUIDELINES.
Codes for acute (G89.11) and chronic (G89.21) pain due to trauma are found in Category G89. These codes should not be assigned if the cause for the pain is documented, unless that the purpose of the encounter is pain management. In order to use these codes, the physician must document the pain as acute or chronic.
Category G89 contains four codes for acute and chronic post-thoracotomy pain (G89.12, G89.22) and other postprocedural pain (G89.18, G89.28). “Routine or expected postoperative pain immediately after surgery” should not be coded as per the ICD-10-CM guidelines. In order to assign these codes, the physician must document that the patient’s pain is a complication of the surgery.
The primary diagnosis will be the complication, if the patient is experiencing pain associated with a specific postoperative complication, such as painful wire sutures. A code from category G89 as a secondary diagnosis can be coded, if appropriate, to identify whether the pain is acute or chronic.
Code G89.3 [Neoplasm related pain (acute) (chronic)] is assigned to pain caused by a benign or malignant neoplasm in any part of the body. The neoplasm is coded separately. If the purpose of the encounter is pain management, then the pain code can be coded first. Otherwise, the neoplasm is coded first. It is not necessary to assign a site-specific pain code together with G89.3 as per the ICD-10-CM guidelines.
Central Pain Syndrome and Chronic Pain Syndrome
Two codes for pain syndromes exists in Category G89 which is why it becomes important in understanding the difference between them.
Central pain syndrome is defined as “a neurological condition caused by damage to or dysfunction of the central nervous system” and is classified to code G89.0 (Central pain syndrome).
Chronic pain syndrome is chronic pain associated with significant psychosocial dysfunction. Chronic pain syndrome is not synonymous with chronic pain. Only when the physician specifically documents it, the condition should be coded and is reported with code G89.4 (Chronic pain syndrome).
It is very important to have a clean and comprehensive documentation to avoid errors in coding and in denial management.