Neurology & Pain Management Coding Alert

Patients with neurogenic pain (for example, trigeminal neuralgia or postherpetic neuralgia), which causes intense discomfort and extreme sensitivity to touch or other stimuli resulting from damage to the peripheral nerves or the central nervous system, can be especially difficult to treat. Fortunately, coding for management of neurogenic pain is mostly a simple matter of supplying the appropriate documentation. Be Sure You Meet the Requirements Neurogenic pain is initiated or caused by a primary lesion, dysfunction or transitory perturbation in the peripheral or central nervous system and is usually chronic. Typically, insurers define chronic 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." But in some cases, such as nerve damage, neurogenic pain is more appropriately described as acute, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. Whether the pain is chronic or acute, a diagnosis of neurogenic pain includes assessing the location and duration of the pain and circumstances surrounding the onset of the condition (including potential medication interactions). Further, the physician should investigate the effect of the pain on the patient's physical and psychosocial function because symptoms associated with chronic neurogenic pain also include sleeplessness and depression. Many physicians will also perform a thorough neurological examination and order neurophysiological studies (for example, electromyography or nerve conduction studies) to assist in their diagnosis, Hammer says. Common diagnoses for neurogenic pain include:
053.10 Herpes zoster, with unspecified nervous system complication
053.12 postherpetic trigeminal neuralgia
053.13 postherpetic polyneuropathy
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. Note that 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. Other causes of neurogenic pain can include chemotherapy, amputation (phantom limb pain), alcoholism, HIV infection or AIDS, spinal cord trauma, multiple sclerosis, and stroke. Drug Administration Dominates Treatment Because even the slightest stimulation may cause extreme discomfort for neurogenic pain patients a condition that may manifest as hyperesthesia (extreme sensitivity to stimulation), hyperalgesia (increasing pain to normally painful stimuli) or allodynia (pain due to normally nonpainful stimuli) physicians generally treat them with drugs rather than with more traditional physical therapy methods. Drug therapy may include antidepressants, such as amitriptyline (J1320), which is effective for postherpetic neurogenic pain but less effective with trigeminal neuralgia; antiepileptics, such as carbamazepine (J3490) and phenytoin (J1165); and antiarrhythmics, such as mexiletine (J3490). Other common treatments for these [...]