General Surgery Coding Alert

Call on a definitive dx if available

You may be tempted to report several new pain codes introduced in ICD-9 2007, but in most general surgery-related circumstances, you probably shouldn-t.

Why? Because in most cases, the pain codes aren't the most specific diagnoses available.

The new-for-2007 pain codes include:

- 338.0 -- Central pain syndrome

- 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

- 338.3 -- Neoplasm-related pain (acute) (chronic)

- 338.4 -- Chronic pain syndrome.

The rules: Medicare guidelines state that you should assign a code from 338.1x or 338.2x only if the doctor hasn't yet made a definitive diagnosis.

If the surgeon has already made a definitive diagnosis, you should list that first and the pain diagnosis second, if at all.

A specific diagnosis requires a more specific code than one from 338.2x, says Kelly Dennis, MBA, CPC, ACS-AP, president of Perfect Office Solutions Inc. in Leesburg, Fla. For instance, you should use 338.3 for cancer-associated pain.  

In addition, hospitals are reluctant to document symptoms, like pain, rather than diagnoses because of significant diagnostic-related group payment differences.

Tip: CMS and the National Center for Health Statistics (NCHS) have issued new ICD-9 coding guidelines, which apply to the new pain codes, among others. You may view the guidelines for yourself at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf.

You should use 338.4 only when your patient actually has -chronic pain syndrome,- according to CMS guidelines. -This condition is different than the term -chronic pain,- and therefore this code should only be used when the provider has specifically documented this condition,- it says.

The descriptor for 338.4 specifies that pain should be -associated with significant psychosocial dysfunction,- which may limit the code's use, Dennis says.