Question Including pain code in dx

cmleinenbach

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If the dx's on an Office Visit dictation includes a pain code along with the other dx's do you code the pain code too? For example:

Diagnosis
Pain, right shoulder.
Right shoulder impingement
Arthritis of right shoulder

Would you include the M25.511 along with the M75.41 and M19.011
 

Orthocoderpgu

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It's wrong, it probably won't get denied but it's incorrect coding. As professional coders we are taught to submit the diagnosis code for the disease or pathology that is being treated and to omit the signs and symptoms. Signs and symptoms don't need to be included because we know that they naturally occur and you would expect them to. If you have internal audits, and I hope you do, it should be marked wrong.
 
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cmleinenbach

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It's wrong, it probably won't get denied but it's incorrect coding. As professional coders we are taught to submit the diagnosis code for the disease or pathology that is being treated and to omit the signs and symptoms. Signs and symptoms don't need to be included because we know that they naturally occur and you would expect them to.
I appreciate you taking the time to reply and answer my questions..
 

SharonCollachi

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Okay, so a little real-world experience from pain management. Alot of pharmacies won't fill pain meds without a PAIN diagnosis. Some insurance companies won't pay injections without a PAIN diagnosis. You know and I know and everyone knows that certain diseases come with pain. But if the patient needs a joint injection, and the insurance company will only cover it with a pain diagnosis, then I'm coding pain.

I follow the "do you want to be right or do you want to be happy" philosophy. Since coding pain is not fraudulent, I will do it. I will NOT do it if the patient doesn't have it and it was only being done for reimbursement. I WILL do it if the patient has it and the coding world says it's incorrect.
 
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TThivierge

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Hi
To add to the discussion, if the physician documents CHRONIC PAIN in his notes along with the body part, you can code this as additional dx G89.29. Now do not get that confused with Chronic Pain Syndrome or Central Pain which is different level of pain. Also do not forgot the Excludes Rule#1 not to mention R52 Pain NOS not be coded same time.
Lady T:cool:
 

thomas7331

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I agree with SharonCollachi on this - if it's a payer requirement that a pain code be on the claim, and the code is supported by documentation, then I don't find it a problem to submit it this way.

Yes, it would be incorrect per the ICD-10 official guidelines, but there's a big difference between 'wrong' meaning coded incorrectly, and 'wrong' meaning coded fraudulently. Remember that guidelines are just that - a guide, and not a regulation or a law. If you are not misrepresenting the information on the claim, then it is something of a technicality.
 
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