Anesthesia Coding Alert

Neurogenic pain results from damage to the peripheral nerves or the central nervous system. Patients often experience searing, chronic pain associated with conditions like trigeminal neuralgia and postherpetic neuralgia. Neurogenic pain can be notoriously difficult to treat due in part to the patient's sensitivity to touch and other stimuli over diffuse regions. Nonetheless, a number of treatment options may be performed by a pain management specialist. Understanding what is typically involved in diagnosing and treating these disorders, and how to code and bill for treatment, can help in obtaining appropriate reimbursement. Factors in Diagnosing Neurogenic Pain As with the description of many forms of chronic pain, most carriers' local medical review policies (LMRPs) define neurogenic pain as a condition present continuously or intermittently for six months or more, or extending two to three months beyond the expected recovery time for postsurgical patients. Mary Jo Marcely, CPC, senior vice president of NAPA Management Services, an anesthesia and pain management consulting firm in New York, says that in diagnosing chronic pain, the physician must thoroughly evaluate the patient. "Two components of the E/M service history and examination are especially crucial. In most situations, a detailed or comprehensive level of history and examination (level three or four) is appropriate for the chronic-pain patient," she says.

The correct E/M code also depends on the site of service. For example, if the physician performed these services for a new patient in an office or other outpatient setting, he or she may choose to use E/M codes 99203 or 99204 (depending on the level of history, evaluation and medical decision-making). Diagnosis includes assessing the location and duration of the pain and circumstances surrounding the onset of the condition (including potential medication interactions). Further, the effect of the pain on physical and psychosocial function should be investigated because symptoms associated with chronic neurogenic pain also include sleeplessness and depression. Many physicians also will perform a thorough neurological examination and order neurophysiological studies to assist in their diagnosis.

Common diagnosis codes for neurogenic pain include: 053.10 Herpes zoster, with unspecified nervous system complication 053.12 postherpetic trigeminal neuralgia 053.13 postherpetic polyneuropathy 053.19 other 350.1 Trigeminal neuralgia (tic douloureux, trigeminal neuralgia NOS and trifacial neuralgia) Trigeminal neuralgia involves a facial nerve disorder but also includes disorders of the fifth cranial nerve. Kelly Dennis, CPC, president of Perfect Office Solutions in Leesburg, Fla., and president of the Florida Anesthesia Administrators Association, says, "Postherpetic trigeminal neuralgia differs from trigeminal neuralgia in that it is defined as severe oral or nasal pain following a herpes zoster infection (shingles). Postherpetic neuropathy refers to multiple areas of pain. It is important for pain management coders to recognize the distinction between these diagnoses." Diagnosis,Efficacy and Medical [...]