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Thread: new pain managment coder

  1. #1

    Default new pain managment coder

    AAPC: Back to School
    I am new to pain management coding and was informed to play close attend when coding hospital consults.. I was told that the doctor wont get paid if I coded the reason for the pain (meaning if the patient just has back surgery and I coded stenosis as the pri dx ). He stated for his bill to get paid I would have to code some type of chronic pain bc of his speciality . Is this true?

    PLease help confused

  2. #2
    Join Date
    Apr 2007


    In order to bill a consult you need to have the following

    A request from appropriate source and reason for the consult documented in your medical record

    The physician then has render the consultation; the note should address who the requesting doctor was and the consulting opionion or recommendations. When Medicare use to pay for consultations, "the intent of the request" was big point. The consulting doctor should understand what the intent of the request is and be able to respond accordingly.

    A written report back to the requesting is required.

    You will see this type of information in the CPT Manual. I would let your previous source know that it is absurb that they are stating dx drives payment for a consultation.

  3. #3


    Right I understand the request for consult.. Maybe my question was that clear. I am asking if an pain magement dr is request for a patient in the hospital. THe ICD-9 cod e for the reason the pain management dr was consulted would be the surgery pain or would it be something in the area of v58.71- v58.78? I was told if we code the surgery pain 1st as pri dx it would get denied because it is understood that the surgeon would take care of post-op pain... if the clear.

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    what you need is a pain code from the 338.xx codes. Read the guidelines for the pain codes, but these codes were created for the purpose of pain management and control encounters.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Join Date
    Apr 2007


    Where I was coming from is that in order for you to use any dx it has to be in the impression or diagnoses section of the consultation. My point of view is you can only abstract what Diagnoses are documented. Didn't mean to sound harsh or misread your question. But like the other post you received. If documented, 338.18 Other acute postoperative pain might capture the reason for the encounter better than a V code. Then additional diagnoses to point where the pain lies such as 719.46 719.41 719.45. Or a V code for status post total arthroplasty such as V43.64 or V43.65 could also be used if it was that type of surgery.

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