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Orthopedic Coding Alert

Reader Questions:

Get Specifics When Billing Chronic Pain

Published on Sun May 28, 2006

Question: Which diagnosis code should I report for chronic pain?

California Subscriber

Answer: The term -chronic pain- normally means that the patient has had the pain condition for more than three months. Seeing this term on a chart makes your job more difficult because it's so general.
 
Some coders recommend reporting 780.99 (Other general symptoms) in this situation, but others balk at using such a nonspecific descriptor. A diagnosis such as 729.1 (Myalgia and myositis, unspecified) could work if the patient has chronic muscle pain and meets the criteria for fibromyalgia.

Ideally, your physician will give you more information so you can code according to the site of pain (such as 724.2, Lumbago, for low back pain).

Encourage your physicians to document more specific diagnoses so you-ll have the details to ensure accurate coding. Asking questions such as -Where is the patient's pain?- or -What hurts?- helps you narrow your coding choices.
 
Note: The upcoming edition of ICD-9 will include several new pain diagnoses. See our cover story for more details on the new diagnosis codes.
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