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Thread: Pain management, pain control

  1. #1

    Default Pain management, pain control

    AAPC: Back to School

    I am new into the internal medicine specialty and I am having a problem trying to find an ICD9 code(s) that my Hospitalist's use for patients for pain management/pain control.

    I researched a little bit and on one web site AHIMA.org under their Postoperative Pain" guidelines they indicate that, "If, however, the patient is being seen for pain control or management, a code from category 338 should be assigned as the principal or first-listed diagnosis."

    Most of the patients have not had surgery. I am understanding for instance that if the patient has severe cellulitis in the leg and they are giving the patient medication while in the hospital would I code 338.19 with 682.6?

    I hope this makes sense.

    Thank you in advance

    Carlotta M. Mackintosh, CPC
    Inpatient Coder
    303-763-4900 x168

  2. #2

    Default Pain Management

    When we code for pain management visits we always code for the cause of the pain. (e.g. (pain in leg, lumbago, shoulder impingement syndrome, myofascial pain syndrome, etc.) Generalized pain is not a good supporting diagnosis. If the pain is post surgery then you could code that as a second or third code.

    Example: pain presents to the pain clinic for pain in the lower back, lower leg. We code lumbago 724.2 and leg pain 729.5 (pain in limb). If it is postoperative 338.18 for acute pain; 338.28 for chronic postoperative pain.

    Hope this helps

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    If you check the coding guidelines you will find that the AHIMA article was correct, If the purpose of the visit is pain control/management, then you use a 338.xx code first listed. HOWEVER the physician must document wheter the pain is acute or chronic, postoperative we are to assume is always acute unless documented as chronic. You are allowed to list the condition causing the pain as a secondary dx such as DJD, this bypasses the guideline that says do not use a symptom with a definitve dx. Also you may code the site specific pain code with the pain code. The pain code shows whether the pain is acute or chronic and the cause either trauma or post op, or other and the site code tells where it is located.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4


    Thank you both for the quick and very informative reply.

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