Part B Insider (Multispecialty) Coding Alert

Published on Thu Mar 06, 2008 PDF

Don't stop until you find exactly what you need--it's easier than you think

Question: How should I assign a diagnosis if the patient's primary complaint is -back pain-? We see this diagnosis somewhat frequently, but we never know how to report it.

Answer: When you are seeking a pain diagnosis, you should try to identify as precisely as possible the pain's location and/or source. If pain is the primary symptom and you know the location, a quick look at the -Index to Diseases- at the front of your ICD-9 manual will generally provide all the information you need.

Example: The patient has low back pain as his primary complaint. By referencing -pain- in the ICD-9 index and following it to location -back: low,- you will find 724.2 (Lumbago).

Checking this against the tabular listings, you confirm the 724.2 diagnosis, which includes low back pain, low back syndrome and lumbalgia, according to notes in the ICD-9 manual.

Typical -pain- complaints you may see in your practice include 724.2, as well as sacroiliac pain (724.6), pain of the thoracic spine (724.1), unspecified backache (724.5), and possibly headache (784.0).

Remember: For physician services, once the doctor identifies the cause of the pain, you should use the more specific diagnosis or condition, rather than the signs and symptoms (including pain) that prompted the patient to visit the doctor. For in-stance, if the physician confirms a sciatica diagnosis to explain the patient's lower back pain, you should turn from 724.2 to 724.3 (Sciatica).

This will probably differ from how you would bill in a physical therapy practice, where most carriers usually require you to report the reason for the visit rather than the patient's underlying diagnosis. For instance, if a patient has bone cancer in her lower spine and the therapist sees the patient for the associated pain, the therapy coder would report the back pain diagnosis as the reason for the therapy (and not the cancer).