Home Health ICD-9/ICD-10 Alert

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

Indiana Subscriber

Answer: "Chronic pain syndrome" is a poorly defined 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, but the new coding guidelines state to code chronic pain syndrome only when the physician indicates that diagnosis. "Chronic pain syndrome" is different from "chronic pain," the guidelines note.

Other diagnosis possibilities for chronic pain include fibromyalgia/muscular pain (729.1, Myalgia and myositis, unspecified); reflex sympathetic dystrophy/regional pain syndrome (337.2x, Reflex sympathetic dystrophy); peripheral neuropathy (337.0, Idiopathic peripheral autonomic neuropathy); or polyneuropathy (357.2) caused by either diabetes (250.6x, Diabetes with neurological manifestations) or amyloidosis (277.30, Amyloidosis, unspecified).

Best bet: Before you assign a diagnosis, check with the physician to clarify what type of pain the patient has. The patient might initially report pain "all over" (780.96, Generalized pain), 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).

Tip: When in doubt, ask the physician which diagnosis code best suits your claim. To narrow her choices, you might consider making a list of those that seem the most applicable and showing that to her to help her decide.