Pain Codes in ICD-10-CM
abdomen pain | ( R10.-) |
back pain | ( M54.9) |
breast pain | ( N64.4) |
chest pain | ( R07.1 - R07.9) |
ear pain | ( H92.0-) |
ICD-10-CM CATEGORY CODE RANGE SPECIFIC CONDITION ICD-10 CODE Diseases of the Circulatory System I00 –I99 Essential hypertension I10 Unspecified atrial fibrillation I48.91 Diseases of the Respiratory System J00 –J99 Acute pharyngitis, NOS J02.9 Acute upper respiratory infection J06._ Acute bronchitis, *,unspecified J20.9 Vasomotor rhinitis J30.0
The new codes are for describing the infusion of tixagevimab and cilgavimab monoclonal antibody (code XW023X7), and the infusion of other new technology monoclonal antibody (code XW023Y7).
ICD-9-CM Diagnostic Codes Conditions classified to category 338, Pain, not elsewhere classified: • 338.0, Central pain syndrome Dejerine-Roussy syndrome Myelopathic pain syndrome Thalamic pain syndrome (hyperesthetic) • 338.11, Acute pain due to trauma • 338.12, Acute post-thoracotomy pain Post-thoracotomy pain NOS 7 ICD-9-CM Diagnostic Codes
The ICD-10-CM is a catalog of diagnosis codes used by medical professionals for medical coding and reporting in health care settings. The Centers for Medicare and Medicaid Services (CMS) maintain the catalog in the U.S. releasing yearly updates.
If the encounter is for pain control or pain management, assign the code from category G89 followed by the code identifying the specific site of pain (e.g., encounter for pain management for acute neck pain from trauma is assigned code G89. 11, Acute pain due to trauma, followed by code M54.
NOTE: To utilize these chronic pain diagnosis codes, the exact nature of pain should be specifically documented in the patient medical records; such as “chronic” to utilize ICD-10 code G. 89.29 or the diagnosis term “chronic pain syndrome” to utilize ICD-10 code G89. 4.
Use of Category 338 Codes with Pain Codes If the encounter is for pain control or pain management, assign the category 338 code followed by the specific site of pain. For example, an encounter for pain management for acute neck pain from trauma would be coded to 338.11 and 723.1.
5 – Low Back Pain.
The ICD-10-CM Index refers you to the code for angina (I20.9) when the patient’s chest pain is described as “ischemic.” However, other types of chest pain are reported with codes from category R07 (Pain in throat and chest). There is an exception for post-thoracotomy pain, which we’ll discuss later.
In addition to the codes for pain in the various parts of the abdomen, there are codes for: Acute abdomen (R10.0): This is sudden, severe abdominal pain, often accompanied by rigidity of the abdomen.
Category G89 contains four codes for acute and chronic post-thoracotomy pain (G89.12, G89.22) and other postprocedural pain (G89.18, G89.28). The ICD-10-CM guidelines state that you should not code “routine or expected postoperative pain immediately after surgery.” Additionally, in order to assign these codes, the physician must document that the patient’s pain is a complication of the surgery.
For example, you can assign a G89 code to indicate that the pain is acute or chronic. You should assign the site-specific pain code first unless the purpose of the encounter is pain management, in which case the G89 code is first. For example, a patient is referred for ankle x-rays for chronic right ankle pain.
Pleurodynia (R07.81): Spasms of pain in the intercostal muscles, which can be a sign of pleurisy (inflammationof the pleural membranes). Intercostal pain (R07.82): This is pain originating in the intercostal nerves, which run between pairs of adjacent ribs.
Pain that does not point to a specific body system is classified in the Symptoms and Signs chapter. For example, abdominal pain is classified to category R10. Certain specific types of pain are classified to category G89 (Pain, not elsewhere classified) in the Nervous System chapter.
Central pain syndrome can occur as a result of stroke, multiple sclerosis, neoplasm, epilepsy, CNS trauma, or Parkinson’s disease. Patients with central pain syndrome may experience localized pain, burning, and/or numbness in specific parts of the body, or throughout the body.
Below is a list of common ICD-10 codes for Pain Management. This list of codes offers a great way to become more familiar with your most-used codes, but it's not meant to be comprehensive. If you'd like to build and manage your own custom lists, check out the Code Search!
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In category R10 of ICD-10-CM, over 30 different codes describe various types of abdominal and pelvic pain. Pain codes in other parts of the abdomen are as follows:
The pain code for angina (I20.9) refers to “ischemic” chest pains. The codes for other types of chest pain are under category (R07) (Chest and throat pain). Post-thoracotomy pain, however, is an exception.
There are times the radiology department will receive a request that states “Pain” without a specific pain location. The ordering physician should provide a complete clinical history of flank pain, knee joint pains, or precordial pain. Otherwise, poor-quality documentation can be a big problem.
The category G89 consists of codes for acute and chronic pains, neoplasm-related pains, and two pain syndromes. The physician or doctor must document that the pain is acute, chronic, or neoplasm-related to assign these codes.
Acute and chronic post-thoracotomy pain (G89.12, G89.22) and other postprocedural pain ( G89.18, G89.28) are from the category G89.
Whenever a benign or malignant tumor produces pain anywhere on the body, use diagnosis code G89.3 to report. The coding is separate from other categories. In cases involving pain management, the pain code should be first on the list. Otherwise, the primary diagnosis will be for neoplasm.
According to the National Institute of Neurological Disorders and Stroke (NINDS), central pain syndrome is a neurological condition characterized by damage or dysfunction of the central nervous system (CNS), including the brain, brainstem, and spinal cord.
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Critical Care Services — Medicare's final ruling has been released. This article discusses the changes to critical care services, including bundled services, concurrent services, global surgery, time spent performing CCS services, and documentation requirements. It also lists the two new modifiers.
Postoperative pain not associated with a specific postoperative complication is reported with a code from Category G89, Pain not elsewhere classified, in Chapter 6, Diseases of the Nervous System and Sense Organs. There are four codes related to postoperative pain, including:
The key elements to remember when coding complications of care are the following: Code assignment is based on the provider’s documentation of the relationship between the condition and the medical care or procedure.
Determining whether to report postoperative pain as an additional diagnosis is dependent on the documentation, which, again, must indicate that the pain is not normal or routine for the procedure if an additional code is used. If the documentation supports a diagnosis of non-routine, severe or excessive pain following a procedure, it then also must be determined whether the postoperative pain is occurring due to a complication of the procedure – which also must be documented clearly. Only then can the correct codes be assigned.
Postoperative pain typically is considered a normal part of the recovery process following most forms of surgery. Such pain often can be controlled using typical measures such as pre-operative, non-steroidal, anti-inflammatory medications; local anesthetics injected into the operative wound prior to suturing; postoperative analgesics;
Only when postoperative pain is documented to present beyond what is routine and expected for the relevant surgical procedure is it a reportable diagnosis. Postoperative pain that is not considered routine or expected further is classified by whether the pain is associated with a specific, documented postoperative complication.