CODING CORNER: Get the Latest Word on the New Postoperative Pain Codes

New guidelines heal fracture coding confusion
ICD-9 2007 expanded your options for reporting pain with several new codes. But do you know when it’s appropriate to report them?

The Centers for Medicare & Medicaid Services and the National Center for Health Statistics (NCHS) have issued new ICD-9 coding guidelines, just in time to help you learn to use all of the new diagnosis codes that took effect Oct. 1. The guidelines are available online at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf.

The new pain management codes include the following:

• 338.0 -- Central pain syndrome

• 338.11 -- Acute pain due to trauma

• 338.12 -- Acute post-thoracotomy pain

• 338.18 -- Other acute postoperative pain

• 338.19 -- Other acute pain

• 338.21 -- Chronic pain due to trauma

• 338.22 -- Chronic post-thoracotomy pain

• 338.28 -- Other chronic postoperative pain

• 338.29 -- Other chronic pain

• 338.3 -- Neoplasm-related pain (acute) (chronic)

• 338.4 -- Chronic pain syndrome.
Learn the rules: The guidelines say you should only assign a code from 338.1x or 338.2x if the doctor hasn’t yet made a definitive diagnosis. If the doctor has already made a definitive diagnosis, then you should list that code first and the pain diagnosis code second, if at all. You should use the codes from 338.1x and 338.2x when the main purpose of the visit is pain management, they add.

“Since a significant number of visits to a pain specialist are for the specific reason of controlling chronic pain caused by a previously diagnosed condition, physicians should be specific when they document the diagnosis,” says Joanne Mehmert, CPC, of Joanne Mehmert & Associates in Kansas City, Mo.

For example: If the patient suffers chronic pain due to lumbar spondylosis, the physician should document this in the record. This enables you to assign 338.29 for other chronic pain and 721.3 (Lumbosacral spondylosis without myelopathy) to give a complete picture of why the patient was treated, Mehmert says.

If the pain isn’t specified as acute or chronic, you can’t assign codes from category 338, unless the pain is post-thoracotomy pain, postoperative pain, or neoplasm- related pain. In most situations, acute pain is obvious, Mehmert says. For example, postoperative conditions or a recent fall or accident would indicate acute pain. But coders should be especially careful to check for documentation of chronic pain, she says. “The docs really need to say ‘chronic,’ or a coder should not label the pain as chronic.”

Fracture care: Separately, the new guidelines specify that you should report pathologic fractures using subcategory 733.1 when the patient is receiving “active treatment” or the fracture. Once the patient has completed active treatment, use aftercare codes in subcategories V54.0, V54.2, V54.8 or V54.9. Similarly, use 800-829 for active treatment of traumatic fractures and aftercare codes for aftercare.

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- Published on 2007-01-14