Examining pain disorders exclusively related to psychological factors requires a complex understanding, especially with the changes implemented on October 1, 2023, set by the 2024 edition of ICD-10-CM. This essential shift, applicable to annotations and deeply rooted in the American ICD-10-CM version, significantly impacts the coding and billing processes for chronic pain management.
As we delve into the complexities of coding, distinguishing between acute and chronic pain, exploring common diagnoses, and understanding diagnostic assessment coding, it becomes evident that staying abreast of these updates is crucial for healthcare professionals.
Defining Pain
Pain can be classified into two types, namely acute pain and chronic pain.
The two can be differentiated on the basis of the duration that it takes to resolve. The ones that resolve along with the recovery of the body are called acute pain, but the pain that persists for a longer duration of time and takes much longer is called chronic pain.
- Basic coding descriptions and terminology for chronic pain
- Common Diagnosis
- Diagnostic Assessment Coding
Coding Chronic Pain
Coding chronic pain depends on various factors, which can be grouped under:
- Basic coding descriptions and terminology for chronic pain
- Common Diagnosis
- Diagnostic Assessment Coding
Basic Coding Descriptions and Terminology
Something that forms the basis of coding chronic pain correctly, is the basic knowledge about the anatomical terminologies. A few examples of this would be mono for unilateral and bi for bilateral. Another term would involve the region of the body, such as the lumbar, which would be the lower part of the back.
It is also important to note that many procedures are not straightforward and are coded based on depth and location. An example of this would be laceration repair. Not only would the coder need to know the location of the repair, but also the depth, such as subcutaneous or fascia, along with the size of the laceration.
Chronic pain can also be experienced in any part of the body, but there are few common locations where chronic pain is most commonly found:
- Joint pain.
- Back pain.
- Neck pain.
- Cancer pain near a tumor.
- Headaches, including migraines.
- Testicular pain (orchialgia).
- Lasting pain in scar tissue.
- Muscle pain all over (such as with fibromyalgia).
- Neurogenic pain, from damage to the nerves or other parts of the nervous system.
Now let’s examine the ICD Codes for pain management.
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 can also cause certain behavioral health issues such as:
- Anxiety.
- Depression.
- Fatigue, or feeling overly tired most of the time.
- Insomnia, or trouble falling asleep.
- Mood swings.
Diagnostic Assessment Coding
Behavioral Assessment Testing
Behavioral assessment testing is done to explain and predict behavior. An example of this testing would be assessing the emotions and behavior of a patient for mental health disorders such as depression or attention–deficit/hyperactivity disorder. This is when the provider scores on the various tests administered and documents the results.
Here are some examples of related coding:
- Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation per standardized instrument (96160)
- Neuropsychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed (96132 for first hour and 96133 for each additional hour)
- Physical performance test or measurement (eg, musculoskeletal, functional capacity), with a written report (97750 for each 15 minutes)
- Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio (95921)
Not all insurance will recognize nor pay for these codes. Or they may cover only a portion of mental health and behavioral services. It is vital to do pre-authorization checks to ensure eligibility.
Conclusion
As you can see, medical coding and billing for Chronic Pain Management is very complex, with codes scattered between Category I and Category III of the AMA CPT codebook. It is essential that your coding team stay up to date on the latest coding changes and that coding audits are conducted on a regular basis to improve coding accuracy and consistency.
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