Guidelines Coders Should Follow to Pick Pain Codes

Coding Guidelines
Coding Guidelines

ICD-10-CM, the system that healthcare providers use to classify and code diagnoses and procedures of care provided, specifies certain guidelines to choose the codes assigned to pain management. Medical coding professionals should update their knowledge about the official guidelines for coding and reporting in order to assign codes with the highest levels of accuracy.  The official guidelines for coding and reporting are approved by the four cooperating parties for the ICD -10-CM – The American Hospital Association, CMS, NCHS and AHIMA. These guidelines are to be complied with under the Health Insurance Portability and Accountability Act (HIPAA) while assigning ICD-10-CM codes. Here are some of the important points for professionals in medical coding jobs that need to be considered for pain coding.

  • Medical coders need to remember that pain associated with psychological factors has one code while pain exclusively associated with psychological factors has a different code.
  • The code F45.41 code is to be assigned to pain disorders exclusively related to psychological factors.
  • The code F45.42 code is to be assigned to pain disorders with related psychological factors.
  • Medical coding companies need to assign a G89 code according to the official guidelines when there is a documentation of psychological component for a patient with acute or chronic pain.
  • Certain sequencing is to be followed when multiple codes are to be used and this is detailed in the guidelines.
  • People in medical coding jobs should follow these guidelines perfectly and when multiple codes are essential, the sequence should not deviate.
  • The usual rule to be followed is that the G89 code has to be used first when the reason for a patient’s encounter or admission is pain management.
  • For a pain management encounter, the G89 code followed by site-specific pain code should be given when both G89 code and site-specific are appropriate.

Medical coding companies and coders dealing with pain diagnoses should understand the official guidelines thoroughly and use them aptly so that they assign the accurate pain codes that are specific to the case and diagnoses.  They should also refer to the ICD-10-CM tabular list and the provider’s documentation for coding encounters for pain due to trauma, post-procedural pain, etc. that are considered chronic pain, not elsewhere classified.

Guidelines Coders Should Follow to Pick Pain Codes
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