Neurosurgery Coding Alert

Question: I often see physicians document -chronic pain- as a diagnosis. Is there a better choice than the 338.XX-series codes for this condition?

Indiana Subscriber

Answer: The ICD-9 manual's alphabetical index offers a fairly long and inclusive list of -pain- diagnoses, including a code for generalized pain (780.99), added in 2003, and the 338.XX-series codes describing various chronic and acute pain conditions, added in 2007. These include the following:

 - 338.0 -- Central pain syndrome
 - 338.18 -- Other acute postoperative pain
 - 338.19 -- Other acute pain
 - 338.21 -- Chronic pain due to trauma
 - 338.28 -- Other chronic postoperative pain
 - 338.29 -- Other chronic pain
 - 338.3 -- Neoplasm related pain (acute) (chronic)
 - 338.4 -- Chronic pain syndrome.

As you suspect, however, these pain codes aren't the most specific diagnoses available in most cases. In fact, Medicare guidelines state that you should assign a code from the 338.1X- or 338.2X-series only if the doctor hasn't yet made a definitive diagnosis. If the physician has already made a definitive diagnosis, you should list that first and the pain diagnosis second, if at all.

In addition, you should use 338.4 only when your patient actually has -chronic pain syndrome,- according to CMS guidelines. -This condition is different than the term -chronic pain,- and therefore this code should only be used when the provider has specifically documented this condition,- CMS states.

The descriptor for 338.4 specifies that pain should be -associated with significant psychosocial dysfunction,- which further limits the code's use.

Take a different approach: Rather than cite an imprecise pain diagnosis, you should ask the physician to pinpoint the pain's location and code accordingly.

For example, a patient with back pain might 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. This will allow for better patient care and ease claims payment.