ED Coding and Reimbursement Alert

Question: What is the best diagnosis code for chronic pain syndrome?


Indiana Subscriber
Answer: -Chronic pain syndrome- is a vague diagnosis, which means it sometimes becomes a catchall term for several pain conditions. ICD-9 directs you to code 338.4 (Chronic pain syndrome) for the condition.

Other diagnosis possibilities for chronic pain syndrome include fibromyalgia/muscular pain (729.1, Myalgia and myositis, unspecified); reflex sympathetic dystrophy/regional pain syndrome (337.2x, Reflex sympathetic dystrophy) or peripheral neuropathy (337.0, Idiopathic peripheral autonomic neuropathy) caused by either diabetes (250.6x, Diabetes with neurological manifestations) or amyloidosis (277.30, Amyloidosis, unspecified). Among the listed alternatives for 338.4, coders choose 729.1 most commonly as a substitute for the generic chronic pain syndrome diagnosis code.

Best bet: Before you assign a diagnosis, check with your physician to clarify what type of pain the patient has. The patient might initially report pain -all over,- but he may be able to pinpoint his worst pain sites, such as the lower back (724.2, Lumbago) or the hip (719.45, Pain in joint; pelvic region and thigh).

Also verify any of the patient's pain-related symptoms before selecting a final diagnosis. Potential symptoms could include back muscle spasms (724.8, Other symptoms referable to back) or derangement of joint (718.95, Unspecified derangement of joint; pelvic region and thigh).

When in doubt, ask the physician which diagnosis code best suits your claim. To narrow her choices, consider listing those that seem the most applicable and showing that to her to help her decide.