Pain Management Coding: Do Injury Codes Apply To Pain?

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You could be using the wrong code if you are not aware what differentiates an acute condition from a chronic one, or how many diagnosis codes you can report. Here's a common question to help your pain management coding (ICD-9).


When can you report an acute injury ICD-9 code rather than a chronic injury code? We tend to patients for generalized pain (not necessarily a recent injury) and are not sure what to code.


Answer: While coding some conditions like kidney disease (584.x and 585.x), often you can easily figure out when the patient's condition is chronic since the diagnosis codes differ based on the patient's lab results. However, coding for pain can be trickier.


Here's an instance: Think that your patient presents with shoulder pain, which came on slowly, that she says she has had for the last nine months. You can think about 840.4; however it is from ICD-9's "injury" chapter. In this instance, the patient did not have an injury; in its place she had nine months of ...
... pain. As such, you should stay away from 840.4 and choose another code based on the rest of your physician's documentation. Most likely you'd look for notes pertaining to the patient's signs and/or symptoms, such as 719.41 if your provider hasn't determined what is causing the patient's shoulder pain and hasn't given a definitive diagnosis. Once a definitive diagnosis has been reached, you no longer need to code the symptoms.


Here's why: Generally acute pain results from disease, surgery, inflammation, or injury. The pain happens to be immediate and normally short-lived. By comparison, chronic pain can originate with an initial trauma or injury however continues beyond the time for normal healing. Many practices use the ‘three months or longer' guideline for coding chronic pain conditions in comparison to acute problems. "A definitive guideline has not been addressed by Centers for Medicare & Medicaid; but it has identified coverage of electrical stimulation for chronic wounds as ‘longer than one month'.


Bottom line: You should leave the determination of acute versus chronic to the physician. If an ICD-9 or CPT code compels you to differentiate between whether the patient's condition is acute or chronic, show both descriptors to the pain specialist and ask him to take a stance.


ICD-9 includes code family 338.xx for acute and chronic pain diagnoses. However, as per Section 1.B.6 of the ICD-9 Guidelines, do not assign codes from category 338.xx if you don't have an "acute" or "chronic" distinction. The sole exception to this guideline lie with post-thoracotomy pain, postoperative pain, neoplasm related pain, or central pain syndrome. If acute or chronic is not specified, you need to look elsewhere for the code.


For more on this and for other specialty-specific articles to assist your pain management coding, sign up for a good medical coding resource like Coding Institute.