Pain Management Coding Alert

Published on Wed Sep 03, 2014 PDF

Check out how much more detailed your choices will be in 2015. 

A patient reporting to your practice with a painful joint can be fairly straightforward to code for, even before a condition such as chronic pain syndrome might be diagnosed. You currently have 10 options based on the affected anatomic site, but your ICD-10 choices will expand to be even more detailed beginning in October 2015. 

ICD-9 coding: Today, you turn to code family 719.4x (Pain in joint …) for these patients. The specific coding options are: 

• 719.40, Pain in joint site unspecified
• 719.41, Pain in joint involving shoulder region
• 719.42, Pain in joint involving upper arm
• 719.43, Pain in joint involving forearm
• 719.44, Pain in joint involving hand
• 719.45, Pain in joint involving pelvic region and thigh
• 719.46, Pain in joint involving lower leg
• 719.47, Pain in joint involving ankle and foot
• 719.48, Pain in joint involving other specified sites
• 719.49, Pain in joint involving multiple sites.

ICD-10 changes: The codes are further distinguished by laterality in ICD-10. Your expanded choices will be:

• M25.50, Pain in unspecified joint
  
• M25.511, Pain in right shoulder
• M25.512, Pain in left shoulder
• M25.519, Pain in unspecified shoulder
• M25.521, Pain in right elbow
• M25.522, Pain in left elbow
• M25.529, Pain in unspecified elbow
• M25.531, Pain in right wrist
• M25.532, Pain in left wrist
• M25.539, Pain in unspecified wrist
• M25.551, Pain in right hip
• M25.552, Pain in left hip
• M25.559, Pain in unspecified hip
• M25.561, Pain in right knee
  
• M25.562, Pain in left knee
• M25.569, Pain in unspecified knee
• M25.571, Pain in right ankle and joints of right foot
• M25.572, Pain in left ankle and joints of left foot
• M25.579, Pain in unspecified ankle and joints of unspecified foot.

Note: Notice how the sixth digit signifies the anatomic location. For instance, right = 1, left = 2, and unspecified = 9. Although you will have codes for unspecified sides or unspecified joints, always code to the highest specificity. 

In addition, the ICD-10 descriptors refer to “pain” in a specific anatomic site (such as “Pain in right elbow,” rather than “Pain in joint involving upper arm” used in ICD-9). Some providers have mistakenly reported 719.43 (Pain in joint involving forearm) for elbow joint pain in ICD-9.

Documentation: Your physician probably already documents the anatomical region where the patient complains of joint pain. After ICD-10 goes into effect, you will have a way to reflect this on your claim. Now is the time to review your provider’s documentation, to ensure they are accurately noting the specific joint as well as the laterality. This specificity can be particularly important in injury-related claims.

Here’s how you will locate these codes specific to joint pain in your Alphabetic Index:

Pain(s) (see also Painful) R52

- joint M25.50
- - ankle M25.57-
- - elbow M25.52-
- - foot M25.57-
- - hip M25.55-
- - knee M25.56-
- - shoulder M25.51-
- - toe M25.57-
- - wrist M25.53-
- shoulder M25.51-

Extra coding help: You’ll find Excludes2 notes with category M25 of ICD-10.For example, reporting any of these joint pain codes with the ICD-10 codes for pain in parts of the patient’s limb, such as pain in hand (M79.64-), pain in fingers (M79.64-), pain in foot (M79.67-), pain in limb (M79.6-), and pain in toes (M79.67-) codes isn’t likely but still possible. Your physician’s documentation needs to support this.