Wiki ‘Nerve type pain’ vs neuropathic pain

[jstambrown]

I’m wondering if anyone has further insight on the following claim/feedback from a GL on why ‘nerve type pain’ is not a valid dx. I will preface by saying I disagree with the logic presented and would add that ‘nerve type pain’ (which I believe is an okay way to dx neuropathic pain) was supported in the exam: ‘There is no support for nerve pain, the details describe "nerve type pain" which is synonymous to "like" or similar to" therefore it really is not confirmed.’ I don’t agree that this is a known convention/synonym

 

[thomas7331]

I'm not sure I can accurately answer your question without the complete context of the medical record you're referring to. But if the provider's documentation is saying that 'there is no support for nerve pain', then in my reading, the provider is saying that the the patient is reporting a symptom that resembles nerve pain but for which the provider can not find any clinical indication that it is in fact a nerve-related condition. So if the provider's assessment is that it is not definitively nerve pain, it would be inappropriate to code it as such. I think it's always important to take the provider's words in the context of the entire note, or to query for clarification if the statements aren't clear.

 

[SharonCollachi]

Nerve pain is a huge component of our practice (Pain Management). I would say that pain doctors (mine, at least), use words in ways they want to use words. In my world, nerve-type pain, nerve pain, and neuropathic pain would all be the same thing. When I was asking him one day about a diagnosis, he stressed that the patient's condition (whatever that condition was, I don't remember) was "severe" and to make sure I billed it that way. I told him that the diagnosis in question did not have any qualifiers, it was either there or not there. He continues to document things like "fibromyalgia, severe" no matter what I say.

Regarding pain, there is no test to show you what hurts for each patient. It's not like an xray that will show a broken bone. You can do a nerve conduction study, but take two patients with the same results, and one will have severe pain and one will report no pain.

Just a few thoughts.

 

[jstambrown]

I'm not sure I can accurately answer your question without the complete context of the medical record you're referring to. But if the provider's documentation is saying that 'there is no support for nerve pain', then in my reading, the provider is saying that the the patient is reporting a symptom that resembles nerve pain but for which the provider can not find any clinical indication that it is in fact a nerve-related condition. So if the provider's assessment is that it is not definitively nerve pain, it would be inappropriate to code it as such. I think it's always important to take the provider's words in the context of the entire note, or to query for clarification if the statements aren't clear.

Thanks for your response. Management had a problem with the provider’s dx of ‘nerve type pain’ although support for neuropathic pain was present in the exam— he just didn’t use the ‘right verbiage.’ The quote in the original post is from management vs. the clinician. In asking around, it seems like 1/2 of those asked say they find the dx to lack decisiveness.

 

[jstambrown]

Nerve pain is a huge component of our practice (Pain Management). I would say that pain doctors (mine, at least), use words in ways they want to use words. In my world, nerve-type pain, nerve pain, and neuropathic pain would all be the same thing. When I was asking him one day about a diagnosis, he stressed that the patient's condition (whatever that condition was, I don't remember) was "severe" and to make sure I billed it that way. I told him that the diagnosis in question did not have any qualifiers, it was either there or not there. He continues to document things like "fibromyalgia, severe" no matter what I say.

Regarding pain, there is no test to show you what hurts for each patient. It's not like an xray that will show a broken bone. You can do a nerve conduction study, but take two patients with the same results, and one will have severe pain and one will report no pain.

Just a few thoughts.

That is helpful. It is likely that this is one of those company-dependent scenarios/guidelines. Thanks

 

[thomas7331]

Thanks for your response. Management had a problem with the provider’s dx of ‘nerve type pain’ although support for neuropathic pain was present in the exam— he just didn’t use the ‘right verbiage.’ The quote in the original post is from management vs. the clinician. In asking around, it seems like 1/2 of those asked say they find the dx to lack decisiveness.

Why does management have a problem with a doctor's 'verbiage'? Physicians may use whatever terminology they deem appropriate to describe a patient's condition. It's not the role of management or any other non-clinician to tell providers how to word their documentation. Seems like they are splitting hairs with this.

Like I said before, if a provider's documentation is not clear, then the appropriate response is to query for clarification or an addendum, not to tell them they aren't using correct verbiage.