Essential ICD-10-CM Updates for Chronic Pain Management in 2025

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Evaluating pain disorders linked to psychological factors requires a careful approach, especially with the important updates rolled throughout last year’s ICD-10-CM edition.   

These changes, built into the American ICD-10-CM guidelines, directly affect how chronic pain  management is coded and billed. 

Looking ahead, staying on top of chronic pain management coding 2025 updates, whether it’s sorting out acute vs. chronic pain, recognizing common diagnoses, or applying the right assessment codes, remains essential for healthcare professionals focused on accuracy and smooth operations.

Table of Contents

Defining Pain

Pain typically falls into two categories: acute and chronic. 

Acute Pain 

 

 Sudden onset pain that typically lasts less than 3 months, associated with a specific injury or condition. It serves a protective function, warning the body of potential harm and usually resolves as the underlying cause heals. 

 

Chronic Pain 

 Pain that persists or recurs for longer than 3 months, often without a clear cause. It is considered a separate medical condition that may arise from abnormal neural function and can significantly impact daily life and emotional well-being. 

 

The key difference lies in how long it lasts. Acute pain fades as the body recovers, while chronic pain sticks around for much longer, often persisting well beyond the initial injury or condition. 

Key Factors for Coding Chronic Pain

Coding chronic pain correctly relies on a few essential elements:  

  • Basic coding descriptions and terminology 
  • Common diagnoses 
  • Diagnostic assessment coding 

Basic Coding Descriptions and Terminology

Accurate coding for chronic pain begins with a solid understanding of anatomical terminology. For instance:  

  • Mono” indicates something unilateral (one side), while “bi” points to both sides. 
  • Terms like “lumbar” refer to specific body regions – in this case, the lower back.  

Coding often requires more detail than location alone. For instance, with laceration repairs, coders must document the site, depth (e.g., subcutaneous or fascia), and size of the laceration. 

Chronic pain commonly affects areas like:  

  • Joints 
  • Back 
  • Neck 
  • Tumor sites (cancer pain) 
  • Head (including migraines) 
  • Testicles (orchialgia) 
  • Scar tissue 
  • Muscles (as with fibromyalgia) 
  • Nerves and nervous system (neurogenic pain) 

 

Now, let’s look at the relevant ICD codes for pain management. 

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ICD 10 Code For Pain Management

Common Primary Chronic Pain Diagnosis Codes
ICD-10-CM Description
G89.21 Chronic pain due to trauma
G89.28 Other chronic postprocedural pain
G89.29 Other chronic pain
G89.4 Chronic pain syndrome
Common Secondary Chronic Pain Diagnosis Codes
ICD-10-CM Description
G90.511 Complex regional pain syndrome I of right upper limb
G90.512 Complex regional pain syndrome I of left upper limb
G90.513 Complex regional pain syndrome I of upper limb, bilateral
G90.521 Complex regional pain syndrome I of right lower limb
G90.522 Complex regional pain syndrome I of left lower limb
G90.523 Complex regional pain syndrome I of lower limb, bilateral
G90.529 Complex regional pain syndrome I of unspecified lower limb
G90.59 Complex regional pain syndrome I of other specified site
G89.0 Central pain syndrome
G96.12 Meningeal adhesions, spinal, cerebral
G54.0 Brachial plexus disorders
G54.1 Lumbosacral plexus disorders
G54.6 Phantom Limb Syndrome; with pain
G54.8 Other nerve root and plexus disorders
G54.4 Lumbosacral root disorders, not elsewhere classified
G56.40 Causalgia of upper limb, unspecified
G56.41 Causalgia of right upper limb
G56.42 Causalgia of left upper limb
G56.80 Other specified mononeuropathies of unspecified upper limb
G56.90 Unspecified mononeuropathies of unspecified upper limb
G56.91 Unspecified mononeuropathies of right upper limb
G56.92 Unspecified mononeuropathies of left upper limb
I70.229 Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
M54.12 Radiculopathy, cervical region
M54.13 Radiculopathy, cervicothoracic region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region

Other Issues Caused by Chronic Pain

Chronic pain doesn’t just affect the body, it can take a toll on mental and emotional well-being, leading to behavioral health challenges such as:  

  • Anxiety. 
  • Depression. 
  • Fatigue, or feeling overly tired most of the time. 
  • Insomnia, or trouble falling asleep. 
  • Mood swings.  

These issues often necessitate behavioral assessment testing and diagnostic assessment coding as part of chronic care management. 

Diagnostic Assessment Coding

For patients with chronic conditions like dementia or ADHD, diagnostic assessments are often a key component of their care. These assessments may include psychological or neuropsychological evaluations:   

  • Psychological testing focuses on emotions and behavioral patterns. 
  • Neuropsychological testing delves into neurobehavioral disorders, cognitive processes, and brain-related conditions.  

Accurately coding and addressing these assessments ensures that patients receive comprehensive care tailored to both their physical and mental health needs. 

Behavioral Assessment Testing

Behavioral assessment testing helps explain and anticipate behavior by evaluating emotions and actions. This type of testing is often used to diagnose mental health conditions like depression or attention-deficit/hyperactivity disorder (ADHD). During these assessments, providers score tests and document results to guide treatment decisions. 

Relevant Coding Examples

Here are a few examples of codes used for behavioral assessment and related services: 

Code 

Description 

96160  

Administration of patient-focused health risk assessment (e.g., health hazard appraisal), including scoring and documentation using a standardized instrument. 

96132  

Neuropsychological testing evaluation by a physician or qualified healthcare professional, covering data integration, interpretation of test results, clinical decision making, treatment planning, and feedback to the patient, family, or caregiver (first hour) 

96133  

Each additional hour of neuropsychological testing evaluation. 

97750  

Physical performance tests or measurements (e.g., musculoskeletal or functional capacity), with a written report (billed per 15 minutes). 

95921  

Testing of autonomic nervous system function (e.g., cardiovagal innervation) involving two or more measures, such as heart rate response to deep breathing, Valsalva ratio, and 30:15 ratio. 

Insurance Considerations 

Not all insurance plans cover these services, and some may only reimburse part of the cost for mental health and behavioral assessments. Performing pre-authorization checks is key to confirming eligibility and avoiding unexpected expenses. 

Takeaways for Effective Pain Management Coding Practices

Coding and billing for Chronic Pain Management can present significant challenges, with relevant codes spread across Category I and Category III of the AMA CPT codebook. Staying current with the latest updates and conducting regular coding audits is essential to ensure accuracy and consistency in order to improve revenue cycle management. 

With over 12 years of experience in the healthcare industry, Neolytix has been a trusted partner for healthcare organizations, refining revenue cycle management processes, including coding and billing.   

Our expertise helps practices secure better reimbursements and improve operational efficiency. 

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Don’t forget to check out our other 2025 medical coding and billing guides to stay ahead and fully prepared for the year’s updates. 

Explore how Neolytix can support your practice by scheduling a demo today.  

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