pain at bone graft donor site


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I cant seem to find a code for post-op pain at donor site...

Looking at post-op pain G89.18 ?
T86.838A - other comp of bone graft ?

any thoughts would be appreciated...


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Donor Site Pain

This is a challenge for coding. It is common for patients to complain of more severe pain from the donor site than the pain from the operative site where the graft was implanted, particularly when the donor site is the Iliac Crest, which is the site that provides the best quality and most quantity of bone for grafting. Therefore, I am assuming that the patient in question had their graft taken from the Iliac Crest. Next is the issue as to whether the postoperative donor site pain constitutes a "complication" or not. Unless there is a wound healing problem at the donor site, then I would not call the excess pain a "complication," but just postoperative pain. If, however, the patient is seen in the office postoperatively with a Chief Complaint of Donor Site Pain, and it is something that warrants medical time and attention, and treatment, then it probably warrants being coded.
I don't think a Site of Pain Code can be used because it is not "Hip Joint Pain" (M25.55 _), nor is it "Low Back Pain" (M54.5), even though the patient may regionalize or localize his pain to the hip or back. It is Pelvic Bone Pain, which is not included in Site of Pain Codes.
R52: Pain,unspecified is no good because it is "unspecified," and it Excludes Acute and/or chronic pain, NEC (G89. _) and Site of Pain Codes as discussed above.
G89.18: Other Acute Postoperative or Post-procedural Pain is probably the best, but is not as specific as it probably needs to be to stand alone.
Of the T Codes for "Complications" of musculoskeletal procedures involving implants and grafts,implantsT84.8 _: Other specified complications of internal orthopedic prosthetic devices, and grafts includes T84.84: Pain, and can be supplemented with a G89 code if the encounter is for "Pain Management," which would be appropriate if the patient's Chief Complaint was the Donor Site Pain. The descriptor does not seem to exclude the donor site as the source of pain, although it most likely is intended for excessive pain at the operative site where the graft was implanted. But, then again, harvesting the bone from the Donor Site was an operative site as well. There is also
T86: Complications of Transplanted organs and/or tissues, which includes T86.838: Other Complications of Bone Grafts, but I would consider this to be to vague and "nonspecific" to use.
There is an M Code,and DM96.89: Other Intra-operative and/or Post-procedural Complications Disorders of the Musculoskeletal System, but again this seems too vague and "nonspecific." Postoperative Donor Site Pain could qualify, but I don't think this is the best answer.
Therefore, my best recommendation would be T84.84 supplemented with G89.18 if acute postoperative pain, or G89.28 if it is chronic postoperative pain at the donor site.

This was a long answer to your query, but I hope it helps. It will be interesting to see what others have to say.

Respectfully submitted, Alan Pechacek, M.D.