Neurology & Pain Management Coding Alert

Make the mystery surrounding M00-M99 disappear.

You know all too well that even the most straightforward of diagnoses can result in you having to choose between two or more different ICD-10 codes. And nowhere is that truer than when you have to code diagnoses relating to a patient’s musculoskeletal system.

So, to help take the guesswork out of finding the most specific code possible, here’s some expert advice on coding pain that will reduce your coding pain by helping you find the correct ICD-10 code quickly and accurately.

First, Answer Injury Question

It may seem obvious, but asking this one simple question will help you eliminate a lot of guesswork when your provider’s diagnosis leads to two different possible ICD-10 codes.

Take this example. Your provider documents that a patient had a charley-horse. When you look the condition up in the ICD-10 index, you see two different codes listed: M62.831 (Muscle spasm of calf) and S76.11- (Strain of quadriceps muscle, fascia and tendon).

To find the correct code in this case simply requires you “be aware that the S codes are injury codes that would be used following a specific injury that caused the strain,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

“Knowing that charley-horses are generally not injuries would lead you to code M62.831, which is the first listed code in the index,” adds Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. This is confirmed in the index as the S76.11 code is preceded by the word “traumatic.”

So, as long as the provider has not indicated the condition was not caused by an injury, which seems most likely in this case, you would stay away from the injury codes and report a musculoskeletal code instead.

Figure Out Pain Location

Sometimes, your provider is forced to provide a somewhat general diagnosis of pain. That can lead to further ambiguity among the codes. For example, foot pain can be coded as M25.57- (Pain in ankle and joints of foot) or M79.67- (Pain in foot and toes).

Which of the two do you use? The answer depends on the exact nature of that pain, and your knowledge of ICD-10 chapter divisions can help you narrow down the choice easily. “The M25 code is one of the arthropathy codes, which represent problems with the joints; while the M79 codes represent conditions involving the soft tissue,” Witt points out.

That means “if the pain is in the ankle or another joint within the foot, you would use M25.57- along with a sixth digit to specify which foot, and if the pain is in the soft tissue of the foot or toes, you would use M79.67- along with a sixth digit to specify laterality and whether the pain is in the foot or toes,” according to Moore.

Coding alert: As both codes are Excludes2 codes for each other, it is entirely possible that you could use both in this situation depending on your provider’s documentation.

Know the Terminology — or Learn it

Very often, a basic knowledge of anatomic terms will enable you to make the correct choice between two similar-sounding conditions.

Take this last example. A provider documents that a patient’s pelvis is contracted. Looking up Contraction, muscle, pelvic region in the ICD-10 index yields M62.45- (Contracture of muscle, thigh). But further down the index, you also find “Contraction, pelvis (acquired) (general),” which leads you to M95.5 (Acquired deformity of pelvis).