Neurology & Pain Management Coding Alert

ICD-10 Coding:

Take the Guesswork out of Coding Pain Dx

Published on Fri Aug 20, 2021

Know when to use G89 as primary, secondary Dx.

Coding for patients’ pain is going to be a common occurrence at a pain management clinic, for obvious reasons. Which ICD-10 code you choose for pain, however, might not be so obvious.

The lowdown: The codes in the G89 (Pain, not elsewhere classified) set are where you’ll go to represent your patient’s pain. The exact code you use will depend on the status of the patient’s injuries, the cause of the pain, and the duration of the pain. Knowing all three components is vital to knowing the exact ICD-10 code for your patients’ pain.

Jessica Miller, MHA, CPC, VP revenue cycle at Ortmann Healthcare Consulting Services in South Carolina, recently gave a webinar designed to clear up any G89 coding confusion. Here’s what she had to say.

Know if Pain Is Chronic/Acute

One of the first elements you’ll need to identify is whether the pain is acute or chronic. “Simply defined as pain that lasts at least 12 weeks, chronic pain is one of the most common conditions for treatment,” explained Miller. These are the codes you’ll most often use for acute and chronic pain.

G89.0 (Central pain syndrome)
G89.3 (Neoplasm related pain (acute) (chronic))
G89.4 (Chronic pain syndrome)

Remember, these codes “may be used in conjunction with codes from other categories and chapters to provide more detail about acute or chronic pain and neoplasm-related pain,” said Miller.

Exceptions Mark Absence of G89

There are instances where the patient is certainly suffering pain, but you’ll still leave the G89 ICD-10 code off the claim. “If the pain is not specified as acute or chronic, post-thoracotomy, postprocedural, or neoplasm-related, do not assign codes from category G89.

“Also, a code from G89 should not be assigned if the underlying — definitive — diagnosis is known, unless the reason for the encounter is pain control/management and not management of the underlying condition,” Miller said.

Further, when an admission or encounter is for a procedure aimed at treating the underlying condition (e.g., spinal fusion, kyphoplasty), a code for the underlying condition (e.g., vertebral fracture, spinal stenosis) should be assigned as the principal diagnosis. No code from category G89 should be assigned, according to Miller.

Use G89 As First-Listed Code

You can also use G89 as a first-listed code in several situations. “When pain control or pain management is the reason for the admission/encounter, the underlying cause of the pain should be reported as an additional diagnosis, if known,” explained Miller.

Also, if the patient is admitted for the insertion of a neurostimulator for pain control, assign the appropriate pain code as the principal or first-listed diagnosis.

Also, Use G89 As Code Also

Codes from G89 may be used in conjunction with codes that identify the site of pain (including codes from chapter 18) if the category G89 code provides additional information. For example, if the code describes the site of the pain but does not fully describe whether the pain is acute or chronic, then both codes should be assigned. “In this instance, the documentation must specifically state acute, chronic, central pain syndrome, or chronic pain syndrome,” reminded Miller.

And payers are serious about the documentation for these conditions. Pain must be specifically documented as “chronic” to assign code G89.29. To assign code G89.4, the documentation must specifically state either “chronic pain syndrome” or “chronic pain associated with significant psychosocial dysfunction.” Similarly, “central pain syndrome” is a diagnosis and must be specifically documented to assign code G89.0.

Sequencing Category G89 Codes

Miller explained the sequencing of category G89 codes with site-specific pain codes (including chapter 18 codes) is dependent on the circumstances of the encounter/admission as follows:

If the encounter is for pain control or pain management, assign the code from category G89 followed by the code identifying the specific site of pain.
If the encounter is for any other reason except pain control or pain management, and a related definitive diagnosis has not been established (confirmed) by the provider, assign the code for the specific site of pain first, followed by the appropriate code from category G89.

Examples Highlight Proper G89 Use

Check out these examples from Miller:

Patient reports for pain management for acute neck pain from trauma. Report G89.11 first followed by M45.2 (Ankylosing spondylitis of cervical region) to identify the site of the pain.
Patient reports for pain management for chronic low back pain. Report G89.28 followed by M54.5 (Low back pain) to identify the site of the pain.
Patient reports for insertion of internal stimulator due to chronic pain syndrome with lumbar disc disorder with radiculopathy. Report G89.4 followed by M51.16 (Intervertebral disc disorders with radiculopathy, lumbar region) to identify the site of the pain.

Do This When Payer Doesn’t Recognize G89

There are still some local coverage determinations (LCDs) that don’t recognize G89 codes as primary diagnoses, even when the rules call for it to be coded first. In these instances, Miller says you should do what the LCD requires: “Use the code which does meet LCD guidelines as the first-listed code and add G89.- as a secondary code,” Miller said.