Today we will finish up our look at pain coding, specifically acute pain, chronic pain, and neoplasm-related pain issues.
G89.1 is our subcategory for acute pain. G89.11 identifies acute pain due to trauma. G89.12 would be assigned for acute post-thoracotomy pain. Post-thoracotomy pain not otherwise specified (NOS) is included here at G89.12. G89.18 identifies Other acute postprocedural pain. Included here are our postoperative pain and postprocedural pain NOS options.
The Official Guidelines note the acute form of the pain codes are the default for post-thoracotomy and other postoperative pain not specified as acute or chronic. We would let the provider’s documentation guide our coding of postoperative pain. A good coding reminder to note here would be that routine or expected post-op pain immediately following surgery would not be coded.
G89.2 is our chronic pain subcategory, and we will see a similar code set listing. G89.21 assigns chronic pain due to trauma. G89.22 would identify chronic post-thoracotomy pain. No inclusion terms here; we know that our NOS options are included with the acute code. G89.28 identifies other chronic postprocedural pain.
Finally, we also have G89.29, identifying Other chronic pain.
The International Association for the Study of Pain (IASP) and the Cleveland Clinic agree that the timeframe for chronic pain is pain that lasts longer than three months. However, our Official Guidelines note that “there is no time frame defining when pain becomes chronic pain.” Just as with other diseases and conditions, we would use the provider’s documentation to guide our code assignment.
Keeping this in mind, it is crucial to thoroughly review all documentation to ensure you are assigning the most accurate code possible. If it is noted that a patient has chronic pain following an accident or an injury, G89.21 would be assigned.
This is often a flagged item on coding audits for missed specificity.
We also see there is an Excludes 2 note at G89 that includes those site-specific codes. We know from the Guidelines that with that Excludes 2 note, we can code both the acute or chronic pain code with the site-specific pain code when present and documented.
For neoplasm-related pain we would assign G89.3. Code assignment includes pain due to both primary and secondary sites of malignancy, as well as tumors.
As I noted last week, acute and chronic are non-essential modifiers here; G89.3 assigns for both. For sequencing, we would look at the reason for the patient encounter. If the encounter is for pain management, G89.3 would be assigned as the principal diagnosis. A code for the neoplasm would be assigned as a secondary diagnosis.
If the encounter is for the treatment of the neoplasm, the neoplasm would be assigned as the primary, with G89.3 assigned as secondary. Guidelines here note that it isn’t necessary to assign an additional site-specific pain code with G89.3.
A frequent review of coding guidelines keeps us coding as painlessly as possible.
Programming note:
Listen live today on Talk Ten Tuesday when Christine Geiger concludes her series on coding pain.
Healthcare has been transitioning toward a more digital, interconnected ecosystem for many years, but the pace and magnitude of current changes represent a fundamental shift.
H.R. 1 doesn’t directly rewrite ICD-10 or CPT, but it does change the environment in which you’re coding. The impact is mostly indirect – through
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
