Pain Management Coding Alert

ICD-10 presents chance for greater specificity on extremity pain.

Coding for limb pain when ICD-9 was still the diagnosis law of the land was complicated enough. Since ICD-10’s implementation, however, limb pain patients are more of a potential coding challenge than ever.

That’s because ICD-10 is much more specific than ICD-9. This specificity might dictate that you use more than a single code for extremity pain — even to identify pain in the same limb. If you don’t know when to drill down on limb pain ICD-10s, you risk inaccurate diagnosis coding and compliance headaches.

Take this advice on Dx coding for arm and leg pain and run with it; that way, you’ll be able to paint the most accurate portrait of your patient’s limb pain at each encounter.

Check M79.60- for Limb Pain

When you’re searching for a limb pain ICD-10 code, make a beeline to M79.60- (Pain in limb, unspecified). That’s where all the diagnosis codes for limb pain are contained.

Basic example: Encounter notes indicate a diagnosis of pain in a patient’s right arm. On the claim, you’d report M79.601 (Pain in right arm) for the diagnosis.

If, however, the patient is more specific about the area of the pain, you should choose a more specific code, confirms Catherine Brink, BS, CMM, CPC, president of Healthcare Resource Management in Spring Lake, New Jersey.

Advanced example: Encounter notes indicate a diagnosis of pain in the patient’s upper right arm. In this case, you should report M79.621 (Pain in right upper arm) for the diagnosis. “If the documentation identifies a certain area of a limb, I would choose that code over the general limb pain code,” says Lynn M. Anderanin, CPC, CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois.

This is also how Tina M Boback, CPC, a coder at Dell in the Detroit area, codes limb pain. Whenever the notesallow, Boback says, “I would choose the more specific code.”

Boback concedes, however, that notes don’t always allow for the most accurate diagnosis code. “I would ask the doctor to specify in his note exact location of the pain in limb, but if that’s not going to happen, then I would use an unspecified code,” she explains.

So, in the “advanced example” above, if the notes only indicated right arm pain without any further specificity, you’d opt for M79.603 (Pain in arm, unspecified).

Include Multiple Codes when Pain Affect Multiple Areas

With limb pain patients, things can get tricky if a patient presents with specific pain in different areas of the same limb. In these cases, you want to report the most specific diagnosis code — or codes — possible, Brink confirms.

Example: Encounter notes indicate that the physician performed a level-three evaluation and management (E/M) service for an established patient with a final diagnosis of left upper arm pain and left forearm pain. In this instance, you would be best served to report:

• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity …) for the E/M service
• M79.622 (Pain in left upper arm) appended to 99213 to represent the upper arm pain
• M79.632 (Pain in left forearm) appended to 99213 to represent the forearm pain.

Explanation: Some coders might just select M79.602 (Pain in left arm) for the patient in this example, but you should take your diagnosis coding a step further if at all possible. One of the perks of ICD-10 is that it allows for greater specificity when identifying a patient’s injury or illness, which leads to better patient outcomes. Patients with limb pain will be better off if you can illustrate the exact areas of their pain via ICD-10. 

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