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ICD-10-CM Diagnosis Coding for Pain Medicine

By Lauri Gray, CPC, RHIT
March 05, 2013

ICD-10-CM implementation will present challenges for all physician specialties. However, the benefits of ICD-10-CM in the long run will make overcoming these challenges worthwhile. One reason for making this change is antiquated disease classifications and terminology. Conditions that were once thought to be the same or similar were grouped together or even reported with a single code in ICD-9-CM. The expansion of medical knowledge in the past 30 years has made it necessary to update the classification of diseases and other conditions. In addition, this increased knowledge has led to identification of new diseases and health threats that require new codes. Medical knowledge related to pain and pain syndromes is no exception and this has led to new classifications and codes for the various types of pain.

The most frequently reported codes for pain and pain syndromes are found in two ICD-10-CM chapters which are:

  • Chapter 6 – Diseases of the Nervous System
  • Chapter 13 – Diseases of the Musculoskeletal System and Connective Tissue

Chapter 6 – Diseases of the Nervous System

Codes for some of the more commonly treated pain diagnoses are found in Chapter 6. Pain diagnoses found in this chapter include:

  • Migraine and other headache syndromes (categories G43-G44)
  • Causalgia (complex regional pain syndrome II) (CRPS II) (G56.4-, G57.7-)
  • Complex regional pain syndrome I (CRPS I) (G90.5-)
  • Neuralgia and other nerve, nerve root and plexus disorders (categories G50-G59)
  • Pain, not elsewhere classified (category G89)

Migraine and Other Headache Syndromes

In ICD-10-CM, the various types of migraines are reported with codes in category G43. All migraines must be documented as intractable or not intractable and with status migrainosus or without status migrainosus. Terms that describe intractable migraine include: pharmacoresistant or pharmacologically resistant, treatment resistant, refractory, and poorly controlled. Status migrainosus refers to a migraine that has lasted more than 72 hours. Other headache syndromes are reported with codes from category G44 and include: cluster headaches, vascular headache not elsewhere classified, tension-type headaches, post-traumatic headaches, drug-induced headaches as well as others.

Causalgia

Causalgia, also referred to as complex regional pain syndrome type II (CRPS II), is a type of neuropathic pain that occurs following a distinct nerve injury, usually to a peripheral nerve in an extremity. Symptoms include: continuous burning or throbbing pain along the peripheral nerve; sensitivity to cold and/or touch; changes in skin temperature, color, and/or texture; hair and nail changes, joint stiffness, muscle spasms, weakness and/or atrophy. Causalgia of the upper limb is reported with codes in subcategory G56.4-. Causalgia of the lower limb is reported with codes from subcategory G57.7-. Fifth characters for both the upper and lower limbs identify laterality as unspecified (0), right (1), left (2).

Complex Regional Pain Syndrome I (CRPS I)

Complex regional pain syndrome I is the most common type of CRPS. Like CRPS II (causalgia) it is a type of neuropathic pain that usually occurs following an injury to an extremity. However, in CRPS I there is no direct injury to a nerve. It can also occur following an illness or it can occur without any known cause. CRPS I is reported with codes from subcategory G90.5. Codes are specific to the upper or lower limbs and laterality is also a component of the codes.

Pain Not Elsewhere Classified (NEC)

Pain typically results from an injury or an inflammatory process and it typically resolves as the injury or inflammation heals. Codes for pain NEC are found category G89. This category includes: central pain syndrome, acute pain not elsewhere classified, chronic pain not elsewhere classified, neoplasm related pain, and chronic pain syndrome.

Chapter 13 – Diseases of the Musculoskeletal System and Connective Tissue 

Many pain conditions are a result of musculoskeletal or connective tissue disorders and diseases. Codes for these conditions are found in Chapter 13 of ICD-10-CM. An example of pain classified in Chapter 13 is radiculopathy associated with disorders and diseases of the spine. These conditions are found in block M40-M54 Dorsopathies. Codes for radiculopathy are found in several categories including:

  • M47 Spondylosis – codes for other spondylosis with radiculopathy are listed in category M47.2- and are specific to the following sites:
    • Occipito-atlanto-axial region
    • Cervical region
    • Cervicothoracic region
    • Thoracic region
    • Thoracolumbar region
    • Lumbar region
    • Lumbosacral region
    • Sacral and sacrococcygeal region
  • M50 Cervical disc disorders – codes for cervical disc disorder with radiculopathy are found in subcategory M50.1- and are specific to:
    • Occipito-atlanto-axial region
    • Mid-cervical region
    • Cervicothoracic region
  • M51 Thoracic, thoracolumbar and lumbosacral intervertebral disc disorders – codes for these sites with radiculopathy are found in subcategory M51.1- are specific to:
    • Thoracic region
    • Thoracolumbar region
    • Lumbar region
    • Lumbosacral region
  • M54 Dorsalgia – codes for radiculopathy not associated with spondylosis or disc disorders are found in subcategory M54.1- and are specified to:
    • Occipito-atlanto-axial region
    • Cervical region
    • Cervicothoracic region
    • Thoracic region
    • Thoracolumbar region
    • Lumbar region
    • Lumbosacral region
    • Sacral and sacrococcygeal region

Other conditions related to pain medicine that are classified in Chapter 13 include: cervicalgia, sciatica, low back pain with and without sciatica, thoracic spine pain, joint pain, muscle spasm, myalgia, and fibromyalgia.

Summary

This is just a short review of the many changes to the classification of conditions related to pain medicine. This review also illustrates the increased site specificity of many codes. ICD-10-CM requires that physicians review the code set now to ensure that documentation meets the required level of specificity and so that any documentation deficiencies can be corrected before implementation of ICD-10-CM on October 1, 2014.
 

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