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Pain Disorder diagnosis code?

  1. #1
    Default Pain Disorder diagnosis code?
    Medical Coding Books
    Okay, here's another one. How would you code these for a Psychiatrist:

    Impression: In summary, the patient is an unfortunate 79 year old, female without known prior psychiatric history, who presents with depressive symptoms associated with severe debilitating medical problems, including chronic pain syndrome for which an SNRI antidepressant, Cymbalta, would be a better treatment option for her depressive symptoms.

    Axis I:
    1. Pain Disorder due to spinal mass & degenerative spinal disease.

    My question is this: in the impression he states the patient has chronic pain syndrome 338.4 while under the Diagnosis he states Pain Disorder which is not listed in the ICD-9 index under neither Disorder, pain or Pain, disorder. But with an encoder comes up with 307.89. Which would be the better choice?

    Then adding 733.90 for spinal mass & degenerative spinal disease.

    Thanks for any ideas or thoughts.

  2. #2
    I think 307.89 is out because the doctor stated the pain is due to physical causes. 307.89 is under pain related to psychological factors. I think 338.29 is a good choice because it covers the chronic pain without specifying "chronic pain syndrome". I think the fact that the doctor calls it Pain Disorder in the Diagnosis section of the report implies that he/she may not completely agree that it is "chronic pain syndrome".

    Kimberly A. Sherman, MA, CPC
    Multi-Specialty Physician Coder/Entrepreneur

  3. #3
    Default Chronic Pain
    Yes. I also use 338.29 for chronic pain issues.
    Anita Johnson, CPC, CCS, CPMA, CCS-P
    Orlando, FL

  4. Default chronic pain guidelines
    Be sure to read your use of category 338 coding guidelines in your icd 9 manual. It states that a code from 338.1 and 338.2 should not be used if the underlying (definitive) diagnosis is known, unless the reason for th encounter is pain control/management and not management of the underlying condition. I would query the provider to bring the Chronic Pain syndrome DX into his assessment/plan.

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