Neurology & Pain Management Coding Alert

Get ready for 7-digit specificity explaining sites of pain.

When your physician evaluates and treats patients for joint pain, you have numerous code choices under ICD-9 for diagnosis 719.4x (Pain in joint) based on anatomic site. Code specificity will move from five to seven digits when ICD-10 becomes effective in October 2013.

ICD-10 basics: Currently, ICD-9-CM lists all anatomic sites for joint pain in the same fifth-digit category (719.4x). ICD-10 changes that by listing code options for pain in some joints as M25.5x (Pain in joint); you'll find the rest at M79.6x (Other soft tissue disorders; pain in limb, hand, foot, fingers and toes).

The new codes in ICD-10 also have fifth and sixth character options for more specificity. The choices for M25.5-- are as follows:

• M25.50 -- Pain in unspecified joint
• M25.51 -- Pain in shoulder
• M25.52 -- Pain in elbow
• M25.53 -- Pain in wrist
• M25.55 -- Pain in hip
• M25.56 -- Pain in knee
• M25.57 -- Pain in ankle.

Except for M25.50, each code is further differentiated via the sixth digit by whether the pain in on the patient's right (sixth digit = 1) or left side (sixth digit = 2), or unspecified (sixth digit = 9). For example, the complete code options for Pain in Shoulder are:

• M25.511 -- Pain in right shoulder
• M25.512 -- Pain in left shoulder
• M25.519 -- Pain in unspecified shoulder.

Prepare now: Providers are already accustomed to documenting a fair level of details about a patient's joint pain. That helps your cause when preparing for ICD-10, but notes will need to move to the next level in order to determine the best ICD-10 diagnosis. Ask your providers to begin ramping up their documentation now in preparation for the changes.