Codes from category G89 may be used in conjunction with other site-specific pain codes to identify the nature of the pain such as acute or chronic. 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. Look at the below example representing the guideline:
Case Example: Patient is seen to evaluate chronic left knee pain.
In this example, the reason for visit is only to evaluate the pain condition and not any underlying condition. Therefore assign M25 codes defining the pain condition of specific site with laterality as the primary diagnosis. However M25 code series does not describe the nature of the pain as acute or chronic. In this instance, you need to report G89 codes to provide more specificity as “chronic pain”.
This article mainly focuses on the sequencing of G89 codes with site specific pain codes. However if you need to know about the appropriate use of G89 codes only, click on the below link:
Sequencing of 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:
Guideline: 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.
Example: Management of acute, traumatic right shoulder pain by the administration of steroid injections.
Rationale: The reason for the encounter is to manage or control the pain and not to treat or evaluate an underlying condition. Therefore category G89 pain code is assigned as the first-listed diagnosis. However this code does not fully describe the condition as it does not include the site and laterality. The M25 pain code is added to provide this information.
Guideline: 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.
Example: Patient is suffering from chronic epigastric abdominal pain. Laboratory tests are ordered to investigate the source of the described pain.
Rationale: In this example, only the source of epigastric pain is investigated and not any pain management is performed in the encounter. Therefore site specific pain codes are assigned as primary codes followed by the G89 code sets to identify the chronic pain.
Figure: Sequencing of G89 codes with site-specific pain codes
Happy learning! Happy coding!