Pain Management Coding: Does Injury Codes Apply To Pain?

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Here's pain management coding scenario to help your understanding: When can you report an acute injury ICD-9 code rather than a chronic injury code? We treat patients for generalized pain (not necessarily a recent injury) and are not sure what to code.


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


Say for instance your patient presents with shoulder pain, which came on slowly; that she says she had for some time. You think about 840.4; however it's 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 avoid 840.4 and choose another code based on the rest of your physician's documentation. You'd most likely look for notes pertaining to the patient's signs and/or symptoms, such ...
... as 719.41 of your provider has not determined what is causing the patient's shoulder pain and hasn't given a definitive diagnosis. And once a definitive diagnosis has been reached, you no longer code the symptoms.


Here's why: Acute pain normally results from disease, surgery, inflammation or injury. The pain is immediate and normally of a short duration. By contrast, chronic pain typically persists beyond three to six months and can last from weeks to a lifetime. Chronic pain can originate with an initial trauma or injury; however continues beyond the time of normal healing. Many practices use the ‘three months or longer' guideline for coding chronic pain conditions versus acute problems. A definitive guideline hasn't been addressed by CMS, even though it has identified coverage of electrical stimulation for chronic wounds as longer than a month.


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.