Pediatric Coding Alert

ICD-10 offers 1-, 2-code options for arm/leg pain.

When patients report to your pediatric practice complaining of limb pain, you’ll need to know some ICD-10 basics in order to report the proper code.

In short: Specificity might dictate that you use more than a single code — 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.

Kick your limb pain diagnosis coding concerns to the curb with this primer on how to select the right code — or codes — to represent your patients’ limb pain.

Look to 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.

Choose Multiple Dx Codes when Pain Affects 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 pediatrician performed a level-two evaluation and management (E/M) service for a new patient with a final diagnosis of left up­per arm pain and left forearm pain. In this instance, you would be best served to report:

• 99202 (Office or other outpatient visitfor 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 …) for the E/M service
• M79.622 (Pain in left upper arm) appended to 99202 to represent the upper arm pain
• M79.632 (Pain in left forearm) appended to 99202 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.