The US healthcare system relies heavily on diagnostic and classification codes, as they play an essential role in the claims reimbursement process. It is important therefore, to accurately code the health care provided to avoid any headaches in your medical practice.
When it comes to ICD 9, the coding is not always straightforward. There are no set guidelines that appear directly within the code set, so understanding the pitfalls is imperative for correct coding especially when dealing with
ICD 9 code for pain.
Everyone experiences pain. However, given that it is one of the most common symptoms for which people seek medical attention, it is also one of the most ineffectively treated and diagnosed conditions. Since it is misunderstood, the ambiguity extends to the medical coding and thus results in coding errors that become a nuisance during reimbursement from insurers.
In this article, we take a look at the most common types of pain, identify how pain affects the body and offer guidelines to properly code for the different types of pain using the ICD 9. Let’s dig in.
Types of Pain
Pain is described as a general term that includes any uncomfortable or unpleasant sensation experienced in the body. Depending on the severity and the laterality, pain is grouped into eight different types which a healthcare provider can identify and provide treatment for.
Usually caused by a specific injury or event, acute pain is described as the pain that starts suddenly and lasts for only a short period of time. Causes may include:
– Cuts or burns
– Broken bone
– Car accident
– Dental work
A pain is categorized under chronic if it has continued for more than six months and is felt most of the time. Chronic pain typically starts off as an acute pain that continues even after a person has recovered from the injury or event. Chronic pain severely affects the daily life of the affected, and may lead to social isolation and depression.
Possible causes include the following health conditions:
– Back pain
Characterized by a sharp sudden increase in pain in patients who already are suffering from pain and taking medication for it. It is also known as a pain flare due to its sudden sharp increase, which can be due to a health condition, or due to heavy exercise, illness, stress or coughing.
The level of pain is mostly severe and the location is often the same as where the chronic pain occurs in the patient.
Ever felt an ache or discomfort in your bones, especially during and after exercising? Well, that tenderness is labelled as bone pain, and is usually associated with conditions that affect the function and structure of the bones. These can include bone fracture, leukemia, sickle cell anemia and mineral deficiency.
Nerve pain is the result of nerve inflammation or damage. Also known as neuropathic pain, it is characterized by a sharp, burning or shooting pain that feels more like an electric shock. The pain is often worse at night. Nerve pain can be caused by either of the following:
– Spinal or nerve injury
– Excessive intake of alcohol
– Circulation problems
– Multiple Sclerosis
A phantom pain is defined as the pain that is felt in that part of the body that is no longer there. It is more commonly found in people who have a limb amputated. In the past, doctors believed that phantom pain was more of a psychological problem. But recent analyses have revealed that the pain is real and originates from receptors in the brain and spinal cord.
Soft Tissue Pain
Soft tissue pain results from an inflamed or damaged muscle, ligament or tissue. It is usually attributed to bruises or swelling from an injury. Common causes include:
– Sciatic pain
– Back pain
– Neck pain
– Rotator cuff injury
Due to a network of interconnecting sensory nerves, pain that feels in one part of the body is actually the result of an inflammation or injury from another organ or structure in the body. For instance, during a stroke, pain is usually felt in the left shoulder, right arm and the neck, even though it is the heart that is the culprit.
The Science Behind Pain
In truth, pain is simply a protective mechanism that is important in the evolution process to protect the body from harm and danger.
There are two main types of nerves that detect danger, connected to pain receptors throughout the body. One nerve type relays messages slowly to the brain, which causes a dull, throbbing pain. The other nerve type passes on the messages from the receptors much more quickly, causing sudden, sharp pains.
Some areas of the body, such as the skin, have a lot of pain receptors that make it easier to pinpoint the exact location and type of the pain. Other areas, like the gut, have few receptors which makes it hard to tell the exact location of a stomach ache.
When you touch something dangerous that is bound to hurt you, for instance something hot or sharp, pain receptors in the skin get activated and send signals to the spinal cord which and from there to the brain. Often, the spinal cord sends an immediate signal back to the muscles producing a reflex reaction that allows you to immediately pull away from the source of harm or danger. Usually this happens before you can feel pain.
In the other scenario, the signals reach the thalamus and the part of the brain sorts the information, processes it according to past experiences, expectations, beliefs and culture before sending back a reaction. This is the reason that people have different ways in perceiving pain.
About the ICD 9
The International Classification of Diseases 9th edition Clinical Modification is a set of codes that classify the various diseases, their symptoms, causes and abnormal findings in a standard format. The diagnosis codes consist of three to five digit numbers, each pertaining to a unique category of disease.
The National Center for Health Statistics and the Centers for Medicare and Medicaid Services provide the complete guidelines for reporting and coding in the ICD 9.
Assigning the correct ICD 9 codes to the services given to a patient is important since the data is compiled to collect mortality and morbidity data, as well as for getting reimbursements from insurers on the medical claims. Incorrect diagnosis and subsequently assigning the wrong code can affect the medical coverage of the patient. It is essential, therefore, that healthcare providers and medical coders should be familiar with the coding sets, pay extra attention while documenting and code assignment, and include all the signs, symptoms and diagnoses in the medical record.
ICD 9 code for Pain
The generalized ICD 9 code for pain is 780.96, and additional codes were added to the ICD 9 in 2007 for postoperative pain, central pain syndrome and post thoracotomy pain. In the past, the codes for pain were included in the body systems and symptoms chapters. With the addition of the new codes, a whole new category was created under the nervous system chapter and the ICD 9 codes for pain were added there.
There was very little information previously regarding the postoperative pain in the ICD and it was only indexed to ‘see pain, by site’. But this did not indicate the postoperative nature of the pain. The revisions in the ICD 9 made it possible to further elaborate on these specific types of pains.
Below are some of the commonly applied ICD 9 codes for pain and their corresponding code in the ICD 10:
– ICD 9 code for neck pain is 723.1 – translates to M54. 2 Cervicalgia in the ICD 10
– ICD 9 code for hip pain is 719.45 – translates to M25.559 Unspecified hip pain in the ICD 10
– ICD 9 code for leg pain is 719.46 – translates to M25.569 Pain in unspecified knee in the ICD 10
– ICD 9 code for chronic back pain is 724.5 – translates to M54.89 Other dorsalgia in the ICD 10
– ICD 9 code for chronic low back pain is 724.2 – translates to M54.5 Chronic low back pain in the ICD 10
– ICD 9 code for knee pain is 719.46 – translates to M25.569 Pain in unspecified knee in the ICD 10
The Importance of Documentation
One of the key factors to ensure there are no coding errors is correct documentation and code assignment for the various pain types. Many of the codes are similar with only slight variations, and the healthcare provider’s documentation is essential to properly code the conditions.
For instance, the ICD 9 code for central pain syndrome is assigned the 338.0 code, chronic pain is given 338.4 and other chronic pain is assigned 338.29. As can be observed, the main category is the same and the variations are observed from the subcategories that are assigned to each condition.
Pain Coding Guidelines
With the addition of the new categories and codes for pain, detailed guidelines were added to the Official Guidelines for Coding and Reporting in the ICD 9 CM. It is important for the healthcare provider as well as the medical coder to thoroughly review the guidelines in order for correct code assignment. Moreover, there are some basic guidelines that can should be applied as well defining the underlying principles, such as:
– Signs and symptoms-codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.
– Conditions that are an integral part of a disease process-signs and symptoms that are integral to the disease process should not be assigned as additional codes, unless otherwise instructed by the classification.
Being familiar and fluent in medical coding may not be the top priority for every healthcare provider. But correct assignment of codes and accurate coding is essential in the timely reimbursement of the services provided. Moreover, the codes that are submitted are used by the government to rule out any healthcare fraud. It is important, therefore, to understand the difference between the ICD 9 code for back pain and the ICD 9 code for leg pain as that will secure your practice from any undue trouble and investigations, as well as ensure that you get paid for the services that you provide for your patients. Still, have questions regarding correct coding? Reach out to the medical coding and billing experts at UControl Billing, with a proven record in outsourcing all your coding needs.