Watch Out For Prior Conditions While Coding For Pain Management

By Author: Julia Rose
Total Articles: 89
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Your physician needs to document (and you should code) prior conditions contributing to current complaints if they affect the management of the current condition.


For instance, Prior trauma, such as a previously broken bone, can cause patients to experience back or neck pain. If a patient's pain stems from a previous condition, that diagnoses can also be coded to justify pain management procedures.


Depending on the situation, there may be V codes or late-effect codes that you may use in addition to the current complaint that show a late effect or a personal history of trauma. For instance, in a scenario where chronic neck pain was present due to a prior traumatic vertebral fracture at C6, for instance, you could code this using all that mentioned below.


338.21 - Chronic pain due to trauma; 723.1 - Cervicalgia; 905.1 - late effect of fracture of spine and trunk without mention of spinal cord lesion.


You could even code this as 338.21, 723.1, and V15.51 (personal history of injury-healed traumatic fracture).


But if the fracture was ...
... a pathological fracture, the coding might be different. For example, you might use 338.29 (other chronic pain) and V13.51 (personal history of pathological fracture) in addition to 723.1 code 338.29 is appropriate (instead of 338.21) because a pathological fracture is not considered due to trauma.


The key to correct coding of these contributory conditions is ensuring they are appropriately documented in the medical record. It's important that your provider is aware of how important this information is to justify medical necessity.


For more on pain management coding, you can go for a pain management conference this December.


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