Oncology & Hematology Coding Alert

Be sure your coding complies with ICD-9 official guidelines for pain management.

If you don't know when to check ICD-9 official guidelines, you may have just a 50-50 chance of choosing the proper order for your diagnosis codes.

Case in point: Patients may present to the office for treatment related to pain caused by a neoplasm. In such cases, you will need to determine which diagnosis codes to report, and you will need to decide what order to list the codes in on your claim. With that in mind, consider how you should code the scenario below.

Start by Examining the Neoplasm-Related Pain Case

Read the following scenario and determine proper ICD-9 coding based on the information given. You'll find a helpful hint on which section of the official guidelines to review if you get stuck.

Scenario: The physician documents that a patient with lung cancer (middle lobe, primary malignant neoplasm) presented to the office for the purpose of pain management. The pain is documented as acute and caused by the neoplasm.

Hint: See section I.C.6.a.5 of the Official Guidelines for instructions on properly coding these sorts of encounters. The CDC posts ICD-9 guidelines online at www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm.

Next, Determine Which Neoplasm and Pain Codes Apply

For this scenario, before you can decide what order to put the codes in, you will need to decide which codes to report.

Neoplasm: For a primary malignant neoplasm of the lung's middle lobe, you should report 162.4 (Malignant neoplasm of middle lobe bronchus or lung), says Denae M. Merrill, CPC, HCC coding specialist in Michigan.

Pain: To choose the proper pain diagnosis code, you want to be sure you keep in mind that the neoplasm is the cause. The ICD-9 index entry for pain has several subentries to consider:

• Cancer associated
• Neoplasm related (acute) (chronic)
• Tumor associated.

All three entries point you to 338.3 (Neoplasm related pain [acute] [chronic]). Checking this code in the tabular list proves it is the best option for this case.

Acute/chronic tip: In the sample scenario, the pain is documented as acute. As the code descriptor indicates, the code is appropriate whether the pain is documented as acute or chronic pain, Merrill says.

Authoritative support: The ICD-9-CM Official Guidelines for Coding and Reporting state, "Code 338.3 is assigned to pain documented as being related, associated or due to cancer, primary or secondary malignancy, or tumor. This code is assigned regardless of whether the pain is acute or chronic" (section I.C.6.a.5).

Base Code Order on Encounter Reason

Once you know which codes to report, you must determine which will be first-listed and which will be a secondary code. For this case, where the encounter is for pain management, you should report 338.3 (pain) first followed by 162.4 (neoplasm), says Merrill.

How you know: ICD-9 official guidelines (section I.C.6.a.5) tell you the neoplasm-related pain code should be first-listed "when the stated reason for the admission/encounter is documented as pain control/ pain management." The guidelines go on to instruct that you should report the underlying neoplasm as an additional diagnosis.

Don't overlook: If the patient presents for neoplasm management (for example, if chemotherapy is the reason for the encounter), but the physician documents neoplasm-associated pain, as well, then "338.3 [pain] may be assigned as an additional diagnosis," ICD-9 guidelines state (section I.C.6.a.5).