ICD-9 UPDATE ~ Use These New Diagnosis Codes for Patients With Pain
Published on Mon Nov 27, 2006
338 series unveiled to represent acute, chronic pain ED coders now have a host of new diagnosis codes to add to their claims, thanks to the beefed up ICD-9 manual for 2007.
Since October 1, when the codes took effect, ED coders have had the option of representing their patients- acute and chronic pain complaints with new diagnosis codes from the 338 code series. But there are very specific instances in which you should actually use the new codes, experts say.
-The pain codes are to define unspecified pain areas or to be used as secondary codes to specify the condition and cause of the pain,- explains Debra Tyx, RHIT, coding manager at PBS Inc., in Amherst, N.Y. Report 338 Codes as Secondary Diagnoses According to Michael Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass., the new pain codes in ICD-9 2007 that ED coders will be most interested in are:
- 338.11 -- Acute pain due to trauma
- 338.12 -- Acute post-thoracotomy pain
- 338.18 -- Other acute postoperative pain
- 338.19 -- Other acute pain
- 338.21 -- Chronic pain due to trauma
- 338.28 -- Other chronic postoperative pain
- 338.29 -- Other chronic pain
Important: Most of the time, you-ll use the 338 codes -in conjunction with codes from other categories and chapters to provide more detail about acute or chronic pain,- explains Granovsky. In the ED, you could use these codes in conjunction with chapter 16 and chapter 17 diagnosis codes. Many of these codes are very general in their descriptions, with the exception of 338.12, which you-d use only to report post-thoracotomy pain.
What's the difference between acute and chronic pain? According to Tyx, -acute pain is new to the patient. Chronic pain is not new to the patient -- this could be from a week-old pain to the last 30 years of persistent pain.- If the patient does not describe chronic or acute pain, leave 338 codes off the claim.
Consider this example: A patient who had left hip surgery 10 days ago reports to the ED. The physician performs a level-3 E/M service, during which time the patient says she has recently experienced pain in her left hip. On the claim, you should:
- report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity) for the E/M service.
- attach 719.45 (Pain in joint; pelvic region and thigh) to 99283 as the primary diagnosis.
- attach 338.18 to 99283 as the secondary diagnosis. Here are a few ailments an ED patient might have that, depending on the presentation, might be accompanied by a 338 chronic pain code as a secondary diagnosis: fibromyalgia, reflex sympathetic dystrophy and other chronic [...]
