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Home Health ICD-9/ICD-10 Alert

CODING HOW-TO:

Take The Pain Out Of Pain Coding With These Tips

Published on Thu Aug 25, 2005

Learn when coding a patient's pain won't hurt you.

 Pain often comes with the territory in home health - but coding for it shouldn't. If you automatically list code 780.99 (Other general symptoms, generalized pain) when a patient complains of generalized pain, stop and think about why the patient is in pain, and then proceed from there.

Background: "Pain is the most common reason for patients seeking advice from their physicians," notes Dio Namocatcat, HCS-D, CPC, medical coder and consultant for Visiting Nurse Regional Health Services Inc. in Brooklyn, NY. And it is extremely common among patients receiving home care.

Pain comes in many varieties and stems from many causes. For example, a cancer patient could have pain directly related to a tumor progression (such as bone metastasis) or nerve compression, says Namocatcat. Or pain could be the result of a treatment modality or could stem from a variety of disorders, such as arthritis, kidney stones, etc. Injuries from falls are another common source of pain among home health patients.

Don't Code Expected Pain

Where to start: Given the broad spectrum of pain and its causes, your first step must be to determine what's causing the patient's pain. If the patient has a medical diagnosis to which pain generally is attached, you should not code that pain separately, experts agree. 

For example, you'd expect cancer patients to have pain, notes Judy Adams, RN, BSN, HCS-D, consultant with LarsonAllen Health Care Group in Charlotte, NC. Similarly, "if someone has a hip fracture, you wouldn't code for pain, because you'd expect that anyone with a fracture would have pain," adds Sparkle Sparks, MPT, HCS-D, COS-C, associate consultant with OASIS Answers in Redmond, WA.

Other diagnoses commonly seen in home health for which pain is an integral part are: 

  • 729.1 (Myalgia and myositis, unspecified)
     
  • 724.3 (Sciatica)
     
  • 724.2 (Lumbago)
     
  • 719.4x (Pain in joint)

    (See the coding quiz later in this issue for more examples of situations in which you should NOT code for pain.)

    What to do if you're stumped: If a patient has pain for which her physician has not been able to determine a cause, and you're going to be addressing that pain in home care, you can code it, instructs Sparks.

    Correctly Code Pain in These Instances

    There are a couple of situations in which you should code for a patient's pain, notes Adams:

    If a patient has any psychogenic pain (pain with no known physical cause, assumed to be psychological in nature), list it separately from the medical condition with code 307.80 (Psychogenic pain, site unspecified). Sometimes this pain is the primary reason for the referral to home care, Adams points out.

    Also code for pain in situations where a patient is referred to home care for routine surgical aftercare in which pain is a predominant feature "that extends beyond the typical aftercare time period," Adams counsels. "In these situations, using a pain code may show the focus of care."

    Remember, when you're providing routine aftercare, the assumption is that nothing is out of the ordinary, notes Sparks. So if the patient has extended pain, you'd need to code it to indicate that the patient's condition is unusual, she says.

    Note This Point on Therapy

    The code for generalized pain, 780.99, does not support the provision of physical therapy or occupational therapy under fiscal intermediaries' local coverage decision policies, Adams reminds HHAs.

    That means if you're providing therapy to deal with a patient's pain, you must list a more specific diagnosis code to support medical necessity for that therapy.

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