Neurosurgery Coding Alert

Do you know how long pain must last before it’s chronic?

When you have to submit ICD-10 codes for your patient’s pain, there’s a specific code set you need to go to for your pain diagnoses.

The devil’s in the details, however, as category G89 (Pain, not elsewhere classified) has many mutations you can choose from depending on the site and type of pain.

Help’s here: We asked Jessica Miller, MHA, CPC, VP revenue cycle at Ortmann Healthcare Consulting Services in South Carolina, how to best navigate the G89 pain diagnosis codes. Here’s what she had to say.

Look to These Codes in G89

When you are looking at a G89 pain diagnosis, you’ll choose from one of the following subcategories, Miller explains:

• G89.0 (Central pain syndrome)
• G89.1 (Acute pain, not elsewhere classified)
• G89.2 (Chronic pain, not elsewhere classified)
• G89.3 (Neoplasm related pain (acute) (chronic))
• G89.4 (Chronic pain syndrome)

Breakdown: “Central pain syndrome” is a diagnosis and the provider must specifically document it to assign G89.0. The provider should document the pain as chronic to assign G89.1. Chronic pain is “pain that lasts at least 12 weeks; it’s one of the most common symptoms given for seeking treatment,” according to Miller.

To assign code G89.4, documentation must specifically state either “chronic pain syndrome” or “chronic pain associated with significant psychosocial dysfunction.”

“These codes can be used in conjunction with codes from categories and chapters to provide more detail about acute or chronic pain and neoplasm-related pain,” says Miller.

Observe G89 Exceptions

There are times when you won’t be able to use a G89 code, however — even if the patient is experiencing pain. If the provider doesn’t specify the pain as acute, chronic, post-thoracotomy, postprocedural, or neoplasm-related, you cannot assign codes from G89.

Also, “if the underlying [definitive] diagnosis is known, you cannot assign a code from G89—unless the reason for the encounter is pain control/management and not management of the underlying condition,” Miller explains.

When the patient presents for a procedure aimed at treating the underlying condition (spinal fusion, kyphoplasty), Miller says a code for the underlying condition (vertebral fracture, spinal stenosis) should be assigned as the principal diagnosis — and you should not assign a code from G89.

Code G89 First in These Scenarios

When the patient reports for pain control or pain management, the underlying cause of the pain should be reported as a secondary diagnosis.

Example: When a patient is admitted for the insertion of a neurostimulator for pain control, assign the appropriate pain code as the principal or first-listed diagnosis.

Use G89 As Code Also in These Scenarios

When the category G89 code provides additional information, you should use it in conjunction with codes that identify the site of pain (including codes from chapter 18), explains Miller.

For example, if the code describes the site of the pain, but does not fully describe whether the pain is acute or chronic, then both codes should be assigned.

Use Caution When Sequencing G89 Codes

Sequencing of G89 codes with site-specific pain codes (including chapter 18 codes) is dependent on the circumstances of the encounter. Follow these code sequencing instructions as explained in each of the following examples:

• If the encounter is for pain control or pain management, assign the code from category G89 followed by the code identifying the specific site of the pain.
• If the encounter is for any reason other than pain control or pain management, and a related definitive diagnosis has not been established (confirmed) by the provider, assign the code for the specific site of pain first, followed by the appropriate code from category G89.

• G89.4 (Chronic pain syndrome) for the pain.
• M51.16 (Intervertebral disc disorders with radiculopathy, lumbar region) to identify the site of the pain.