Understanding Category G89 Codes for Pain Management
Before we have detail understanding for category G89 codes, let’s quickly discuss what is ICD-10 CM and overall diagnosis codes for pain management.
Basics of ICD-10 CM
In health care, diagnosis codes are used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification. In medical classification, diagnosis codes are used as part of the clinical coding process alongside intervention codes. The International Statistical Classification of Diseases and Related Health Problems (ICD) is one of the most widely used classification systems for diagnosis coding as it allows comparability and use of mortality and morbidity data.
International Classification of Diseases (ICD) codes are a set of designations used by healthcare staff to communicate diseases, symptoms, abnormal findings, and other elements of a patient’s diagnosis in a way that is universally accepted by those in the medical and insurance fields. The tenth and most recent edition is known as ICD-10. ICD-10 codes are passed to insurance companies to establish the medical necessity of the services a provider is asking to be paid for. There are more than 70,000 of them, and their highly specific definitions are understood by all who use them. Looking up these codes can become quite important if you’re trying to sort out a medical pre-approval or billing issue with your insurance provider. An incorrect code can mean that coverage of practitioner visits and treatments gets denied.
Diagnosis Codes for Pain Management
You can find pain codes in three different places in the ICD-10-CM manual:
- Pain that points to a disorder of a specific body system is classified in the body system chapters. For example, low back pain is classified in the Musculoskeletal chapter (M54.5) and testicular pain is classified in the Genitourinary System chapter (N50.8).
- Pain that does not point to a specific body system is classified in the Symptoms and Signs chapter. For example, abdominal pain is classified to category R10.
- Certain specific types of pain are classified to category G89 (Pain, not elsewhere classified) in the Nervous System chapter.
Understanding Category G89 Codes
Category G89 includes codes for acute pain, chronic pain, and neoplasm-related pain, as well as codes for two pain syndromes. In order for you to assign these codes, the physician must document that the pain is acute, chronic, or neoplasm-related. The ICD-10-CM guidelines state that if the cause of the pain is known, you should assign a code for the underlying diagnosis, not the pain code. However, if the purpose of the encounter is to manage the pain rather than the underlying condition, then you should assign a pain code and sequence it first.
For example, a patient is referred to an interventional radiologist for a facet joint injection. The clinical history is chronic low back pain due to degenerative disc disease (DDD) of the thoracic spine with radiculopathy. Because this encounter is for pain control rather than to evaluate or treat the DDD, you should code the pain first. The primary diagnosis is G89.29 (Other chronic pain), and the secondary diagnosis is M51.14 (Intervertebral disc disorders with radiculopathy, thoracic region).
In another example, an interventional radiologist performs kyphoplasty on a patient who has chronic back pain due to an osteoporotic compression fracture of the thoracic spine. Because this encounter is to treat the vertebral compression fracture, you should code only the compression fracture. The code assignment is M80.08- [Age-related osteoporosis with current pathological fracture, vertebra(e)].
The ICD-10-CM guidelines also state you can assign the G89 codes in conjunction with codes from other categories and chapters to provide more detail about acute or chronic pain or neoplasm-related pain. For example, you can assign a G89 code to indicate that the pain is acute or chronic. You should assign the site-specific pain code first unless the purpose of the encounter is pain management, in which case the G89 code is first.
For example, a patient is referred for ankle x-rays for chronic right ankle pain. The exam does not reveal any findings to explain the pain. In this case you need to assign two codes—one for the ankle pain and one from category G89 to indicate that the pain is chronic. Since the purpose of the encounter is not pain management, the site-specific pain code is listed first. The primary diagnosis is M25.571 (Pain in right ankle). Code G89.29 (Other chronic pain) is assigned as a secondary diagnosis.
Category G89 Codes
- Codes in category G89, Pain, not elsewhere classified, may be used in conjunction with codes from other categories and chapters to provide more detail about acute or chronic pain and neoplasm-related pain.
- If the pain is not specified as acute or chronic, post-thoracotomy, post-procedural, or neoplasm-related, do not assign codes from category G89.
- A code from category G89 should not be assigned if the underlying (definitive) diagnosis is known, unless the reason for the encounter is pain control/ management and not management of the underlying condition.
- When an admission or encounter is for a procedure aimed at treating the underlying condition (e.g., spinal fusion, kyphoplasty), a code for the underlying condition (e.g., vertebral fracture, spinal stenosis) should be assigned as the principal diagnosis. No code from category G89 should be assigned.
Category G89 Codes as Principal or First-Listed Diagnosis
Category G89 codes are acceptable as principal diagnosis or the first-listed code:
When pain control or pain management is the reason for the admission/encounter (e.g., a patient with displaced intervertebral disc, nerve impingement and severe back pain presents for injection of steroid into the spinal canal). The underlying cause of the pain should be reported as an additional diagnosis, if known.
When a patient is admitted for the insertion of a neurostimulator for pain control, assign the appropriate pain code as the principal or first-listed diagnosis. When an admission or encounter is for a procedure aimed at treating the underlying condition and a neurostimulator is inserted for pain control during the same admission/encounter, a code for the underlying condition should be assigned as the principal diagnosis and the appropriate pain code should be assigned as a secondary diagnosis.
Use of Category G89 Codes in Conjunction with Site Specific Pain Codes
Assigning category G89 and site-specific pain codes: Codes from category G89 may be used in conjunction with codes that identify the site of pain (including codes from chapter 18) if the category G89 code provides additional information. For example, if the code describes the site of the pain, but does not fully describe whether the pain is acute or chronic, then both codes should be assigned.
Sequencing of category G89 codes with site specific pain codes: The sequencing of category G89 codes with site specific pain codes (including chapter 18 codes), is dependent on the circumstances of the encounter/admission as follows:
- If the encounter is for pain control or pain management, assign the code from category G89 followed by the code identifying the specific site of pain (e.g., encounter for pain management for acute neck pain from trauma is assigned code G89.11, Acute pain due to trauma, followed by code M54.2, Cervicalgia, to identify the site of pain).
- If the encounter is for any other reason except pain control or pain management, and a related definitive diagnosis has not been established (confirmed) by the provider, assign the code for the specific site of pain first, followed by the appropriate code from category G89.
- The provider’s documentation should be used to guide the coding of postoperative pain. The default for post-thoracotomy and other postoperative pain not specified as acute or chronic is the code for the acute form. Routine or expected postoperative pain immediately after surgery should not be coded.
- Postoperative pain not associated with a specific postoperative complication is assigned to the appropriate postoperative pain code in category G89.
- Postoperative pain associated with a specific postoperative complication (such as painful wire sutures) is assigned to the appropriate code(s) found in Chapter 19 of ICD-10 CM, Injury, poisoning, and certain other consequences of external causes. If appropriate, use additional code(s) from category G89 to identify acute or chronic pain (G89.18 or G89.28).
Chronic pain is classified to subcategory G89.2. There is no time frame defining when pain becomes chronic pain. The provider’s documentation should be used to guide use of these codes.
Neoplasm Related Pain Code
G89.3 is assigned to pain documented as being related, associated or due to cancer, primary or secondary malignancy, or tumor. This code is assigned regardless of whether the pain is acute or chronic. This code may be assigned as the principal or first-listed code when the stated reason for the admission/encounter is documented as pain control/pain management. The underlying neoplasm should be reported as an additional diagnosis.
When the reason for the admission/encounter is management of the neoplasm and the pain associated with the neoplasm is also documented, code G89.3 may be assigned as an additional diagnosis. It is not necessary to assign an additional code for the site of the pain.
Chronic Pain Syndrome
Central pain syndrome (G89.0) and chronic pain syndrome (G89.4) are different than the term ‘chronic pain,’ and therefore codes should only be used when the provider has specifically documented this condition.
Legion Healthcare Solutions is a reliable medical billing company providing complete medical billing and coding services. We referred CMS’s ICD-10 CM guidelines to explain category G89 codes for pain management. You can check below mentioned reference link for detailed understanding. For accurate and quicker insurance payments, you are advised to outsource your medical billing and coding operations. We provide state-specific and medical speciality-specific billing and coding services ensuring accurate claim submission to government as well as private insurance companies. To know more about our medical billing and coding services, contact us at 727-475-1834 or email us at firstname.lastname@example.org
Reference: 2021 ICD-10-CM Guidelines