OASIS Alert

But watch for inconsistencies.

Use new ICD-9 pain codes to help you show how pain impacts the care you provide.

If you can paint a clearer picture of what the patient is experiencing, you can justify additional therapy sessions or treatment to a skeptical reviewer, suggests consultant Marvel Hammer with MJH Consulting in Denver.

Pain codes can explain slower than expected progress toward therapy goals, remind clinicians to include pain management in the plan of care and support a trauma diagnosis in M0230, says coding and OASIS consultant Lisa Selman-Holman with Denton, TX-based Selman-Holman & Associates. 

What changed? In the past, if pain was an expected part of the underlying diagnosis, you could not use a separate symptom code for the pain. Now pain codes are in a new category in the nervous system chapter of the 2007 ICD-9-CM coding manual and coding guidelines allow you to report pain integral to the condition.

Example: Before Oct. 1, for a patient with a neoplasm of the stomach who is experiencing stomach pain, "I would list the neoplasm as the primary diagnosis, and I wouldn't report pain at all because that's included [in the neoplasm diagnosis]," says Lucie Carter Lopez, RN BA HCS-D, clinical supervisor with Interim Health Care in Fresno, CA.

On or after Oct. 1, new code 338.3 (Neoplasm related pain [acute] [chronic]) opens up new possibilities for reporting a cancer patient's pain, Selman-Holman says.
 
Look In The Nervous System Chapter

The new 338.xx series includes 11 new codes to better describe pain conditions:

• 338.0 (Central pain syndrome)
• 338.11 (Acute pain due to trauma)
• 338.12 (Acute post-thoracotomy pain)
• 338.18 (Other acute postoperative pain)
• 338.19 (Other acute pain)
• 338.21 (Chronic pain due to trauma)
• 338.22 (Chronic post-thoracotomy pain)
• 338.28 (Other chronic postoperative pain)
• 338.29 (Other chronic pain)
• 338.3 (Neoplasm related pain [acute] [chronic])
• 338.4 (Chronic pain syndrome).

Caution: List these pain codes as primary in M0230a only if pain management is the focus of your care, Selman-Holman says. And be sure your answers to OASIS items M0420 and M0430 are consistent with your decision to code pain.

Tip: If your state is working on improving pain levels with your Quality Improvement Organization, the new codes will be helpful in indicating a focus of care, Selman-Holman says. Also, if you code for a patient's pain in M0230 because it is the focus of care or in M0240, you'll get risk adjustment for these new nervous system chapter codes in several outcome categories, she says.