Neurosurgery Coding Alert

Look for site specific codes and include psychological factors.

G89 (Pain, not elsewhere classified) is a broad category and learning how to apply these codes is the key to getting your pain diagnoses correct when ICD-10 goes into effect in 2013.

Crucial: Be selective in reporting the codes from the G89 category. These codes are never assigned if the definitive diagnosis is established. The only exception is when the reason for the encounter is pain control and not the management of the underlying condition per se. See the examples below for neurosurgery applications you may encounter:

1) If the neurosurgeon implants a neurostimulator for control of pain, you report the pain code as the principal or firstlisted diagnosis.

2) If the patient presents to the neurosurgeon for management of pain after a displaced intervertebral disc, you report G89 code and the underlying condition can be reported as an additional diagnosis.

3) If the patient reports to the neurosurgeon for spinal fusion, you do not report the G89 category code. You instead report the principal diagnosis; say the spinal stenosis or a vertebral fracture.

Combine G89 with Site-Specific Pain Codes

You can use the G89 category code along with codes that specify the site of pain. You sequence the two codes according to the circumstances.

Example: If a patient sustains an acute neck injury in an accident and your neurosurgeon treats for pain, you assign code G89.11 (Acute pain due to trauma) and also report M54.2 (Cervicalgia) to specify the site of pain. However, if your neurosurgeon is treating the patient for another reason, you assign the G89 code only as a secondary diagnosis. "You can bill the G89 codes with site"specific pain codes," says Teresa Thomas, BBA, RHIT, CPC, practice manager II at St. John's Clinic (Neurosurgery) in Springfield, Missouri.

Note the One-To-One Match

ICD-10 has a one-to-one match for several pain codes in ICD- 9. Below are the choices you will have once ICD-10 goes into effect in October 2013.

Discern Postoperative vs. Postprocedure

In ICD-9, you have 338.18 (Other acute postoperative pain) which corresponds to G89.18 (Other acute postprocedural pain) in ICD-10. Similarly, 338.28 (Other chronic postoperative pain) corresponds to G89.28 (Other chronic postprocedural pain) in ICD-10. There is a change from 'postoperative' to 'postprocedure' in these pairs. "G89.18 covers both postoperative pain NOS and postprocedural pain NOS," says Thomas. "The inclusion of postprocedure pain acknowledges those circumstances where a procedure such as lumbar puncture or other percutaneous treatment results in acute or chronic pain," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Include Psychological Factors

Pain is an emotional experience. There may be an accompanying psychological component which you should not miss. The ICD-10 code for the psychological factors is F45.42 (Pain disorder with related psychological factors) which corresponds to 307.89 (Other, pain disorder related to psychological factors) in ICD-9. Make sure you have supporting documents for the psychological factors. "Under G89, you have Excludes 1 and Excludes 2 information, and the bottom of the Excludes 2 information tells you to Code F45.42 for psychological factors," advises Thomas. "If you use the index and look under pain you will find psychogenic pain that will lead you to the code. Remember, you also need to use the index and then check the tabular for the correct code," she adds.