Pain Management Coding Alert

Question: How would you diagnose orbital pain and facial pain in a patient? During a recent level-two evaluation and management (E/M) service for a new patient, our nonphysician practitioner (NPP) diagnosed both. Is there one ICD-10 code that covers both symptoms?

Colorado Subscriber

Answer: There is no single ICD-10 code for facial pain and orbital pain; you’ll need to rely on a pair of codes to represent this patient’s condition on the claim. Further, “facial pain” is a pretty vague diagnosis, so you’ll have to rely on a less specific code.

Do this: On your 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making …) claim, append R51 (Headache) to represent the patient’s facial pain and H57.1 (Ocular pain) to represent the patient’s orbital pain.

Explanation: Granted, neither of these ICD-10 codes is spot-on for the symptoms you describe; but the symptoms you describe are not specific enough to code any differently. Under the descriptor for R51, ICD-10 lists “Facial pain NOS [not otherwise specified]” as a possible alternate description for the ICD-10 code. When you look up “Pain, orbital” in the ICD-10 index, it directs you to “Pain, ocular”; which is H57.1.

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