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G89 Series: How to Select the Best Chronic Pain Diagnosis Code

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G89 Series: How to Select the Best Chronic Pain Diagnosis Code

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Chronic pain

When CMS introduced chronic pain management codes G3002 and G3003 effective Jan. 1, practices rejoiced at the new options. But coverage for these codes, as is the case with all medical claims, hinges on medical necessity. And the best way to demonstrate that is to report the most accurate ICD-10-CM codes.

To correctly identify the best ICD-10-CM codes for your chronic pain patients, check out a few essential facts.

Never Code Just to Get Paid

The first rule of ICD-10-CM for any condition—including chronic pain—is to code based on the documentation and not based on which codes the insurer will cover. This is a problem that the OIG has identified and spoken out about, and yet practices still sometimes select diagnosis codes based on what will get the claim paid rather than coding based on what reflects the patient’s condition.

To remain compliant, only report diagnosis codes that are documented and supported by the medical record to reflect the patient’s true diagnoses.

Report a G89 Code When Pain Management Is the Reason for the Encounter

According to section I.B.6.b of the ICD-10-CM Guidelines, you can list pain as the primary diagnosis “when pain control or pain management is the reason for the encounter. The underlying cause of the pain should be reported as an additional diagnosis, if known.”

For instance, suppose the patient presents for chronic pain management for chronic back pain. You’d report:

  • 29 (Other chronic pain)
  • 9 (Back pain)

Chronic pain is classified to subcategory G89.2, but there isn’t a specific timeframe defining when pain becomes “chronic.” The provider’s documentation should be used to guide the application of these codes, and any question about whether a patient is experiencing chronic or acute pain should be directed to the provider.

Know the G89.2 Options

Chronic pain syndrome is defined as chronic pain associated with significant psychosocial dysfunction, according to the Institute for Chronic Pain. In other words, the pain itself leads to stressful issues, which cause stress and make the pain worse.

For chronic pain, you’ll look to the following ICD-10-CM codes:

  • 21 – Chronic pain due to trauma
  • 22 – Chronic post-thoracotomy pain
  • 28 – Other chronic post-procedural pain
  • 29 – Other chronic pain
  • 3 – Neoplasm related pain (may be acute or chronic)
  • 4 – Chronic pain syndrome

Knowing the definition of chronic pain, a good best practice is to ensure the documentation includes details about the psychosocial dysfunction that the patient is experiencing due to the chronic pain.

Know How F11 Differs

Some practices gravitate toward ICD-10-CM code F11 (Opioid related disorders) for chronic pain, but if the patient is taking their prescribed pain medications correctly, this code is not appropriate.

If you want to reflect the fact that the patient is on opioids, you can instead report Z79.891 (Long term [current] use of opiate analgesic) as a secondary diagnosis code, listed after the appropriate G89 code.

There’s much more to know about reporting chronic pain management. Let expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO walk you through the facts during her one-hour training, G3002 and G3003: Get Paid More With New Chronic Pain Management Codes. Sign up today!


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