Chronic pain is one of the most common pain types that affects Americans. This type of pain is long-standing and persists for longer than a year. In some cases, acute pain could become chronic.
Coding Chronic Pain
There are different treatment methods depending on the disease and or disorder, the type of pain, and where the pain is located. Coding pain management can range from simple procedures to more complex coding. Code selection will require basic coding knowledge, medical terminology, and coding guidelines. In this article, we will be covering the following:
- Basic coding descriptions and terminology for chronic pain
- Common Diagnosis
- Diagnostic Assessment Coding
Basic Coding Descriptions and Terminology
Knowing common terms and conditions contributes significantly to selecting the correct code. Some examples of this would be acute vs chronic pain. Basic anatomy terms associated with chronic pain identify where most treatments are performed. It is also essential as most main texts are arranged by anatomical systems. There are many pain types; a few are neuropathic and musculoskeletal pain. Let’s look at these more in-depth, along with some examples.
Acute VS Chronic Pain
Acute pain starts suddenly and usually goes away if there is no underlying condition. An example of acute pain would be a reaction to a new condition. An exacerbation of a chronic condition would be considered acute on chronic pain.
Some examples of acute pain would be pain due to an injury or an infection. An acute condition could develop into a chronic condition. Chronic pain is prolonged pain that persists. Some examples of this would be fibromyalgia, arthritis, or migraines. Treatment for chronic pain usually involves being treated for an extended amount of time.
Terminology for Chronic Care Coding
Many of the codes selected require knowledge of medical terminology. Some terms have prefixes that further describe the location. 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 lumbar which would be the lower part of the back.
It is also important to note that many procedures are not straight forward and are coded based on the depth and location. An example of this would be a 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.
Where can Chronic Pain Occur
There are common anatomical regions where the pain can be located. Some of these include neuropathic, and musculoskeletal pain. The musculoskeletal system consists of the bones, muscles, and connective tissues. Many chronic conditions occur in this system. Pain such as chronic lower back pain, rheumatoid arthritis, and tendinitis.
The nervous system involves two main parts. The central nervous system which contains the brain and spinal cord. The peripheral nervous system involves nerves that branch off from the spinal cord which extends to all parts of the body. Some conditions include complex regional pain syndrome, nerve compression, or facial nerve disorders.
Common Locations for Chronic Pain
- Arthritis, or 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.
ICD 10 Code For Pain Management
Common Primary Chronic Pain Diagnosis Codes
Chronic pain due to trauma
Other chronic postprocedural pain
Other chronic pain
Chronic pain syndrome
Common Secondary Chronic Pain Diagnosis Codes
Complex regional pain syndrome I of right upper limb
Complex regional pain syndrome I of left upper limb
Complex regional pain syndrome I of upper limb, bilateral
Complex regional pain syndrome I of right lower limb
Complex regional pain syndrome I of left lower limb
Complex regional pain syndrome I of lower limb, bilateral
Complex regional pain syndrome I of unspecified lower limb
Complex regional pain syndrome I of other specified site
Central pain syndrome
Meningeal adhesions, spinal, cerebral
Brachial plexus disorders
Lumbosacral plexus disorders
Phantom Limb Syndrome; with pain
Other nerve root and plexus disorders
Lumbosacral root disorders, not elsewhere classified
Causalgia of upper limb, unspecified
Causalgia of right upper limb
Causalgia of left upper limb
Other specified mononeuropathies of unspecified upper limb
Unspecified mononeuropathies of unspecified upper limb
Unspecified mononeuropathies of right upper limb
Unspecified mononeuropathies of left upper limb
Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
Radiculopathy, cervical region
Radiculopathy, cervicothoracic region
Radiculopathy, thoracic region
Radiculopathy, thoracolumbar region
Radiculopathy, lumbar region
Radiculopathy, lumbosacral region
Other Issues Caused by Chronic Pain
Chronic pain can also cause certain behavioral health issues such as:
- 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. Some examples of coding are below:
- 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)
- Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report (97750)
- 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. Please check with your local and state Insurance plan’s policy.
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.
Please do not hesitate to contact us directly for assistance with this process. At Neolytix, we are always ready to assist your practice with medical billing, coding, and revenue cycle management.
Our medical billing services are 100% HIPAA-compliant and provided by a certified team of professionals. Likewise, our medical credentialing services are fast, efficient, and organized according to rigorous workflow management procedures.