Neurology & Pain Management Coding Alert

Published on Thu Jun 22, 2017 PDF

Arm yourself for coding battle with this limb pain primer.

Since ICD-10’s implementation, patients reporting to your practice with limb pain are more of a coding challenge than ever.

Why? Specificity might dictate that you use more than a single code — even to identify pain in the same limb. If you don’t know when to drill down on limb pain ICD-10s, you risk inaccurate diagnosis coding and compliance headaches.

Select the right code — or codes — to represent your patients’ limb pain each time with this expert advice.

Go to M79.60- for Limb Pain

When you’re searching for a limb pain ICD-10 code, make a beeline to M79.60- (Pain in limb, hand, foot, fingers and toes). That’s where all the diagnosis codes for limb pain are contained.

Basic example: Encounter notes indicate a diagnosis of pain in a patient’s right arm. On the claim, you’d report M79.601 (Pain in right arm) for the diagnosis.

If, however, the patient is more specific about the area of the pain, you should choose a more specific code, confirms Catherine Brink, BS, CMM, CPC, president of Healthcare Resource Management in Spring Lake, New Jersey.

Advanced example: Encounter notes indicate a diagnosis of pain in the patient’s upper right arm. In this case, you should report M79.621 (Pain in right upper arm) for the diagnosis. “If the documentation identifies a certain area of a limb, I would choose that code over the general limb pain code,” says Lynn M. Anderanin, CPC, CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois.

This is also how Tina M Boback, CPC, a coder at Dell in the Detroit area, codes limb pain. Whenever the notes allow, Boback says, “I would choose the more specific code.”

Boback concedes, however, that notes don’t always allow for the most accurate diagnosis code. “I would ask the doctor to specify in his note exact location of the pain in limb, but if that’s not going to happen, then I would use an unspecified code,” she explains.

So, in the “advanced example” above, if the notes only indicated right arm pain without any further specificity, you’d opt for M79.603 (Pain in arm, unspecified).

Do this When Pain Affect Multiple Areas of Limb

With limb pain patients, things can get tricky if a patient presents with specific pain in different areas of the same limb. In these cases, you want to report the most specific diagnosis code — or codes — possible, Brink confirms.

Example: Encounter notes indicate that the physician performed a level-three evaluation and management (E/M) service for an established patient with a final diagnosis of left upper arm pain and left forearm pain. In this instance, you would be best served to report:

• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity …) for the E/M service
• M79.622 (Pain in left upper arm) appended to 99213 to represent the upper arm pain
• M79.632 (Pain in left forearm) appended to 99213 to represent the forearm pain.

Explanation: Some coders might just select M79.602 (Pain in left arm) for the patient in this example, but you should take your diagnosis coding a step further if at all possible. One of the perks of ICD-10 is that it allows for greater specificity when identifying a patient’s injury or illness, which leads to better patient outcomes. Patients with limb pain will be better off if you can illustrate the exact areas of their pain via ICD-10.