Neurology & Pain Management Coding Alert

Question: If a patient has wrist pain and shoulder pain, should we report each diagnosis, or should we report the "multiple joint pain" code instead?

Texas Subscriber

Answer: You should report both the wrist pain (726.4) and shoulder pain (719.41) diagnoses. Because ICD-9 requires that you code to the highest degree of specificity, reporting both diagnoses is more accurate. If a patient has general aches and pains, or says that when it rains her joints ache, you should report the multiple joint pain code (719.49) instead.

Reporting both 726.4 and 719.41 may help you down the road, depending on whether the neurologist plans to perform any procedures to alleviate the patient's pain. Because the pain in separate sites may not be related, the neurologist may have to use different treatment options for each site. In this case, the separate diagnoses will better support your claims.

If you aren't sure which diagnosis to list first on your claim form, ask the physician which site produced the most pain. If the patient's wrist pain outweighed her shoulder pain, you should list 726.4 first.