Primary Care Coding Alert

Question: What is the best diagnosis code for chronic pain syndrome?


Indiana Subscriber

Answer: -Chronic pain syndrome- is a vague diagnosis, which means it sometimes becomes a catchall term for several pain conditions. Common possibilities include reflex sympathetic dystrophy/regional pain syndrome (337.2x), fibromyalgia/muscular pain (729.1, Myalgia and myositis, unspecified), or peripheral neuropathy (337.0, Idiopathic peripheral autonomic neuropathy) caused by diabetes (250.6x, Diabetes with neurological manifestations) or amyloidosis (277.3).

Check with your physician to clarify what type of pain the patient has before you assign a diagnosis.
 
The patient might initially report pain -all over,- but he should be able to pinpoint his worst pain sites, such as the lower back (724.2, Lumbago) or the hip (719.45, Pain in joint; pelvic region and thigh).

Also verify any of the patient's pain-related symptoms before selecting a final diagnosis. Potential symptoms include back muscle spasms (724.8, Other symptoms referable to back) or derangement of joint (718.95, Unspecified derangement of joint; pelvic region and thigh).

When in doubt, ask the physician which diagnosis code best suits your claim. To narrow her choices, you might consider making a list of those that seem the most applicable and showing that to her to help her decide.

Answers to You Be the Coder and Reader Questions reviewed by Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.