Taking the Pain out of Pain Coding – Part II

Today we will finish up our look at pain coding, specifically acute pain, chronic pain, and neoplasm-related pain issues. 

G89.1 is our subcategory for acute pain. G89.11 identifies acute pain due to trauma. G89.12 would be assigned for acute post-thoracotomy pain. Post-thoracotomy pain not otherwise specified (NOS) is included here at G89.12. G89.18 identifies Other acute postprocedural pain. Included here are our postoperative pain and postprocedural pain NOS options.

The Official Guidelines note the acute form of the pain codes are the default for post-thoracotomy and other postoperative pain not specified as acute or chronic. We would let the provider’s documentation guide our coding of postoperative pain. A good coding reminder to note here would be that routine or expected post-op pain immediately following surgery would not be coded. 

G89.2 is our chronic pain subcategory, and we will see a similar code set listing. G89.21 assigns chronic pain due to trauma. G89.22 would identify chronic post-thoracotomy pain. No inclusion terms here; we know that our NOS options are included with the acute code. G89.28 identifies other chronic postprocedural pain.

Finally, we also have G89.29, identifying Other chronic pain. 

The International Association for the Study of Pain (IASP) and the Cleveland Clinic agree that the timeframe for chronic pain is pain that lasts longer than three months. However, our Official Guidelines note that “there is no time frame defining when pain becomes chronic pain.” Just as with other diseases and conditions, we would use the provider’s documentation to guide our code assignment.

Keeping this in mind, it is crucial to thoroughly review all documentation to ensure you are assigning the most accurate code possible. If it is noted that a patient has chronic pain following an accident or an injury, G89.21 would be assigned.

This is often a flagged item on coding audits for missed specificity. 

We also see there is an Excludes 2 note at G89 that includes those site-specific codes. We know from the Guidelines that with that Excludes 2 note, we can code both the acute or chronic pain code with the site-specific pain code when present and documented. 

For neoplasm-related pain we would assign G89.3. Code assignment includes pain due to both primary and secondary sites of malignancy, as well as tumors.

As I noted last week, acute and chronic are non-essential modifiers here; G89.3 assigns for both. For sequencing, we would look at the reason for the patient encounter. If the encounter is for pain management, G89.3 would be assigned as the principal diagnosis. A code for the neoplasm would be assigned as a secondary diagnosis.

If the encounter is for the treatment of the neoplasm, the neoplasm would be assigned as the primary, with G89.3 assigned as secondary. Guidelines here note that it isn’t necessary to assign an additional site-specific pain code with G89.3. 

A frequent review of coding guidelines keeps us coding as painlessly as possible.  

Programming note:

Listen live today on Talk Ten Tuesday when Christine Geiger concludes her series on coding pain.