Primary Care Coding Alert

Question: A patient has been complaining of chest pain. Our FP has ruled out a heart condition but is considering costochondritis as the diagnosis. What ICD-9 code should I use?

Oklahoma Subscriber

Answer: For costochondritis, the ICD-9 index will point you to 733.6 (Tietze's disease). Both costochondritis and costochondral junction syndrome are bundled into this code.

Be careful: Do not consider these diseases and chest pain as similar diseases. They were bundled into this code because they have similar presenting problems to chest pain. Costochondritis is described as inflammation of the costal (rib) cartilage where it attaches to the sternum of the chest. Tietze's disease, on the other hand, involves the same area of the chest but differs by causing swelling of the affected ribs. In addition, it also causes inflammation and tenderness.

Before using 733.6, be sure that the FP ruled out heart problems. Heart problems (heart attack) usually and more commonly cause chest pain. In all cases of Tietze's disease and costochondritis, a heart attack (for example, myocardial infarction) is the differential diagnosis.

Finally, if a more definitive diagnosis, such as myocardial infarction or costochondritis, cannot be established, code the symptom of "chest pain": 786.5x.