FAQ to Boost Your Pain Management ICD-9 Coding

FAQ to boost your pain management ICD-9 coding

If you do not know how many diagnosis codes you can report, you could find yourself assigning the wrong code. Here's a question followed by the answer that'll help you get quick tips to help your pain management ICD-9 coding:

How many diagnosis codes are 'too many'?

Question: Our pain management specialist treated a patient with diabetes, however he was actually seeing the patient to treat a complication of the diabetic polyneuropathy. During his evaluation, the doctor also noted that the patient has shoulder joint inflammation. Should we use the neuropathy complication only or several ICD-9 codes to represent various conditions of the patient?

Answer: Normally, the primary diagnosis code that you list on your claim should represent the main reason for the encounter, or the condition with the highest risk of morbidity/mortality that the physician tends to during the visit. However, when you deal with a condition like diabetes, the situation changes.

Section 1.A.6 of the ICD-9-CM official

Guidelines for coding and reporting certain conditions have both an underlying etiology and multiple body system manifestations owing to the underlying etiology. For conditions such as this, the ICD-9-CM has a coding convention that requires that the underlying condition be sequenced first after the manifestation.

If a patient has more than one manifestation of diabetes, more than one code from category 250 may be used with as many manifestation codes as are needed to describe the patient's diabetic condition fully.

As such, you should first use 250.6x (Diabetes with neurological manifestations). Remember to add a fifth digit to reflect the patient's type of diabetes and status of control. Your secondary code should represent the specific pain manifestation being treated. In this case, you should report 357.2 (Polyneuropathy in diabetes) as the secondary diagnosis. As because your pain practitioner documented joint inflammation, you should also report the right code describing that condition (716.91, Arthropathy, unspecified; shoulder region).

Why so many codes: Even though many payers will link only the first, main diagnosis code that you list to support the provided service's medical necessity, reporting all the diagnoses that follow the HIPAA-mandated guidelines is compliant coding. As of July 2007, Medicare must accept up to eight diagnoses for each electronic claim reported. The additional diagnoses might indicate more complex presenting problems and can provide the help you might need for a higher-level E/M service.

FAQ to Boost Your Pain Management ICD-9 Coding

By: James Smith

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