Appropriate use of category G89 codes with relevant examples

Most of the coders experience big challenges when coding pain codes. It might be a site specific pain, or acute/chronic pain, there may be several discussions and confusions that exist around the team and finally end up with different codes for a single pain code. To eliminate such issues, simple tips have been provided in this article which would certainly help you in the assignment of correct codes.

ICD-10 CM has listed the pain codes in the category G89 under the chapter “Diseases of the nervous system”. A code from category G89 for pain can be used with the codes from other categories to indicate more details about the nature of pain such as acute, chronic, neoplasm related pain, or post procedural pain. The appropriate use of G89 codes is discussed in this article with relevant examples:

When do you assign codes from Category G89?

The reporting of pain conditions is further divided into categories depending upon the nature of the pain such as acute, chronic, neoplasm related pain, post-thoracotomy, or post procedural pain. A code from G89 category is to be used when one of the above-listed nature and reason of pain is documented in the medical record. Code categories based on the nature of pain is listed below:

  • G89.0 Central pain syndrome
  • G89.11 Acute pain due to trauma
  • G89.12 Acute post thoracotomy pain
  • G89.18 Other acute post procedural pain
  • G89.21 Chronic pain due to trauma
  • G89.22 Chronic post thoracotomy pain
  • G89.28 Other chronic post procedural pain
  • G89.29 Other chronic pain
  • G89.3 Neoplasm related pain (acute) (chronic)
  • G89.4 Chronic pain syndrome

Case Example 1:

The patient presents for chronic right shoulder pain and the physician administered steroid injection for shoulder pain management.

Code assignment:

G89.29 Other chronic pain

M25.511 Pain in right shoulder

Rationale:

In this case, G89.29 should be assigned to identify the type of pain as chronic pain. Per guidelines, codes from other category can be used to provide more detail about the chronic pain such as location. Therefore code M25.511 is used to identify the location of pain in the right shoulder.

When do you NOT assign codes from Category G89?

A code from category G89 should not be used if the definitive diagnosis is known and the treatment is directed towards the underlying condition and not the pain. You need to report G89 codes based on the reason for visit and the management of the underlying condition. If the reason for the visit is only for the pain control and not the management of the underlying condition, then it is appropriate to report G89 as the principal diagnosis.

Look at the below examples representing two different cases:

Scenario: 1

Consider a case with the documentation of a definitive diagnosis and the treatment is directed towards the underlying condition

Case example:

A 75-year old patient with back pain is admitted for outpatient kyphoplasty for age-related osteopathic compression fracture at vertebra T3.

Code assignment:

M80.08XA: Age-related osteoporosis with current pathological fracture, vertebra (e), initial encounter for fracture.

Rationale: In this case, you should not assign G89 series as the pain is inherent in the underlying condition being treated. Only the code for the definitive diagnosis of age related osteoporosis is assigned.

Scenario: 2

Consider a case when the pain control or management is the reason for the visit with the documentation of the underlying cause for the pain.

Case example:

A 25-year old patient presents for steroid injection in the right elbow due to chronic pain associated with primary degenerative joint disease.

Code assignment:

G89.29 Other chronic pain

M19.021 Primary osteoarthritis, right elbow

Rationale: As the encounter is for control of pain and not treating the underlying condition, the pain code is sequenced first followed by the underlying condition. Code M25.521 to identify the location is not necessary as the underlying condition code represents the specific site.

The other categories of G89 codes will be discussed in upcoming article…Stay connected!

Happy learning! Happy coding!

Resources:

https://cdn.optumcoding.com/upload/docs/ICD-10-CM%20for%20Physicians%202018%20Chapter%20Guidelines%20and%20Examples.pdf
https://www.healthicity.com/blog/icd-10-reminder-series-section-1c6-diseases-nervous-system

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