Wiki use of "pain" diagnosis codes

[donsgirl1015]

can someone weigh in on a "debate" in our billing department please - we have billers that will send back notes to the providers because there is not a pain code (joint pain, limb pain) on the superbill. the medical assistant/provider argues that it is not necessary if there is more specific diagnosis. i understood that, if coding a fracture for example, that the pain is inherent to the fracture and you would not code "wrist pain", but would only code the "wrist fracture" but our billing department says that medicare wants/needs the pain code as well. usually i pick my battles, but this just keeps growing. thank you for your input!!!!!

melissa - ortho coder

 

[jademound]

Signs & Symptoms

Signs & symptoms are not coded when a definitive diagnosis is provided. Pain codes are not necessary, nor are they coded, when the cause of the pain is documented. Chapter specific guidelines state this.
Chapter 6: Disease of Nervous System and Sense Organs
a - 1) A code from subcategories 338.1 and 338.2 should not be assigned if the underlying (definitive) diagnosis is know, unless the reason for the encounter is pain control/management and not management of the underlying condition.

It also states "when an admission or encounter is for a procedure aimed at treating the underlying condition, a code for the underlying condition should be assigned as principal diagnosis. No code from category 338 should be assigned".