Neurology & Pain Management Coding Alert

Question: One of our neurologists often cites "chronic pain" as a diagnosis, but I can find no mention of this in ICD-9. Which code(s) is appropriate?

Illinois Subscriber

Answer: If you consult ICD-9's alphabetical index, you'll notice a long and inclusive list of "pain" diagnoses, but nothing for "chronic" or "intractable" pain. Rather, the diagnoses tend to specify an anatomic area, such as "abdominal," "face" or "neck." CMS added a new code for generalized pain (780.99) for 2003, but rather than rely on this diagnosis, you should ask the physician to pinpoint the pain's location.

For example, a patient with back pain may describe the discomfort as arising from the lower back (724.2), coccyx (724.79) or thoracic region (724.1). Remember, always code to the highest level of specificity that the physician can determine accurately. Doing so will allow for better patient care and ease claims' payment.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.