Taking the Pain out of Pain Coding – Part I

Continuing with our look at areas of coding confusion, let’s today examine pain. According to Medline Plus Magazine from the National Institutes of Health (NIH), pain is the most common reason people seek medical care.

We all have felt some type of pain. Let’s look to the Official Guidelines, as we always do when we experience confusion or want more information. 

Category G89 identifies pain. G89.0 identifies central pain syndrome. According to the National Institute of Neurological Disorders and Stroke, a part of the NIH, central pain syndrome is a neurological condition caused by damage or dysfunction of the central nervous system. This may be caused by stroke, epilepsy, Parkinson’s disease, multiple sclerosis, or trauma just to name a few conditions.

Central pain syndrome should be documented as such in order to assign G89.0. G89.1 identifies acute pain, while G89.2 identifies chronic pain. When assigning for acute or chronic pain types, you have further options to identify the pain as due to trauma, pain that is post-thoracotomy, postprocedural pain, and then an option for “other.” The G89.3 code identifies pain that is neoplasm-related. Here acute and chronic are noted to be nonessential modifiers in the Tabular List. G89.4 identifies chronic pain syndrome. The inclusion term here is chronic pain associated with significant psychosocial dysfunction. Chronic pain syndrome would be documented as such in the health record. 

These G89 codes are intended to be assigned in addition to other codes, such as site-specific pain, when additional detail can be provided. If the pain isn’t specified as acute or chronic, post-thoracotomy or postprocedural, or due to a neoplasm, we would not assign a code from G89. We also wouldn’t assign a G89 code when the underlying condition causing the pain is known and the encounter is for treatment of that condition. If, however, the reason for the encounter is pain control or pain management, we would assign a G89 code, if applicable.

The guidelines help us answer a few more frequently asked questions on pain coding, for example: can I use a G89 code as the principal or first-listed diagnosis? The answer is yes – again, when the reason for the encounter is pain control or management. In this case, a code for the etiology of the pain would be assigned as an additional diagnosis. Another instance when a G89 code could be assigned as principal is when the encounter is for insertion of a neurostimulator for pain control. In encounters in which both a neurostimulator is inserted and a procedure is performed to treat the condition causing the pain, the principal diagnosis would be that underlying condition, with the pain code assigned as a secondary diagnosis. 

Let’s look at another question – I have already coded my right knee pain, or my abdominal pain, so do I need to add a G89 code, or is the one code sufficient? Yes, we would code both the site-specific pain code and a code from G89 if there is additional information the G89 code can identify (for example, if the pain is documented to be acute or chronic in nature). Sequencing of these codes is based on the reason for the encounter. If the encounter is for pain management, the G89 code would be sequenced before the site-specific code. If the encounter is for another reason and the etiology of the pain is unknown, the site-specific pain code would be sequenced first, followed by the G89 code. 

A frequent review of coding guidelines helps keep the coding process as pain-free as possible.

Programming note: Listen live when Christine Geiger reports the latest coding news on Talk Ten Tuesday with Chuck Buck and Angela Comfort today at 10 Eastern.