Wiki use of 786.59 vs. 786.50

[lsmft]

One of our new coders as well as our sister facility use 786.59 exclusivly for chest pain regardless of symptoms or documentation because 'it covers everything.' To me there is a difference between the two. What is common practice out there?

 

[jojo2922]

I personally and all the coders I work with use 786.50 unless the documentation specifies the specific type of chest pain. You never want to code something that's not specified in the documentation.

 

[OliviaPrice]

Just my opinion:
786.50 - should be used for chest pain when the specific location is not identified and it is not identified as non-cardiac chest pain.

786.59 - should be used when the documentation states non-cardiac chest pain, chest pain due to a non-cardiac issue, or does not actually state pain instead it lists chest discomfort, pressure, tightness...etc.

The professional edition of ICD-9 has a tip under 786.59 that states:
"Assign for chest pain due to anxiety, along with an additional code for anxiety. Chest pain is not integral to the diagnosis of anxiety." This tip is what lead me to believe if the chest pain is due to a non-cardiac issue the 786.59 should be coded.

Also, per the 2011 GEMs for ICD-10 on the CMS website.
786.59 converts to R07.89 Other chest pain & R07.82 Intercostal pain, which again supports the idea if the pain is non-cardiac use 786.59.