Neurology & Pain Management Coding Alert

Tip: Don't limit yourself to just one ICD-9 code.

If you don't know what differentiates an acute condition from a chronic one, or how many diagnosis codes you can report, you could find yourself assigning the wrong code. Check out two common questions to get quick tips to help your pain management ICD-9 coding.

Do Injury Codes Apply to Pain?

Question 1: When can I report an acute injury ICD-9 code rather than a chronic injury code? We see patients for generalized pain (not necessarily a recent injury) and aren't sure what to code.

Answer 1: When coding some conditions, such as kidney disease (584.x and 585.x), you can often easily determine when the patient's condition is chronic because the diagnosis codes differ based on the patient's lab results. But coding for pain can be trickier.

For example, suppose your patient presents with shoulder pain, which came on slowly, that she says she has had for the past nine months. You consider 840.4 (Sprains and strains of shoulder and upper arm; rotator cuff [capsule]), but it is from ICD-9's "injury" chapter. In this case, the patient didn't have an injury -- instead she had nine months of pain.

Therefore, you should avoid 840.4 and select another code based on the rest of your physician's documentation. You would most likely look for notes regarding the patient's signs and/or symptoms, such as 719.41 (Pain in joint; shoulder region) if your provider has not determined what's causing the patient's shoulder pain and has not given a definitive diagnosis. "Once a definitive diagnosis has been reached, you no longer code the symptoms," reminds Judith L. Blaszczyk, RN, CPC, ACS-PM, compliance officer with Auditing for Compliance and Education, Inc.

Why: Acute pain generally results from disease, surgery, inflammation, or injury. The pain is immediate and usually short-lived. Chronic pain, by contrast, typically persists beyond three to six months and can last from weeks to a lifetime. Chronic pain can originate with an initial trauma or injury but continues beyond the time of normal healing. Many practices use the "three months or longer" guideline for coding chronic pain conditions versus acute problems. "A definitive guideline has not been addressed by CMS, although it has identified coverage of electrical stimulation for chronic wounds as 'longer than one month,' " says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting and Coding Education in Boardman, Ohio.