Balanced Living

Medical Coding for Pain Management Services

Pain Management Code Changes Effective November 2017

Medical Coding for Pain Management Services

Pain management medical coding can be a challenge for busy specialists. Pain can be acute, chronic, or both. Treatment strategies differ depending on the type of pain present. Reliable and consistent documentation of pain management, which includes patient responses regarding improvement in pain scores, detailed and thorough care plans, written long-term plans, and periodic reassessment is essential for improving patient care.

Accurately coded medical reports help:

  • Insurance companies obtain the necessary information to determine coverage for chronic and acute pain conditions
  • Physicians obtain the reimbursement they deserve for services provided to their patients

The most common documentation issues include lack of specificity – “acute” or “chronic”, failure to have a common written language and not documenting all pre-comfort care conditions. Pain management physicians and hospitalists providing pain management services can ensure accuracy in their medical coding with the support of reliable medical coding services.

ICD-10 Pain Management Codes

ICD-10 codes are used for more specific documentation, which include:

  • 18 – Other acute post-procedural pain
  • 28 – Other chronic post-procedural pain
  • 3 – Neoplasm related pain (acute) (chronic)
  • 5 – Low back pain
  • 8 – Other specified disorders of male genital organs
  • 1 – Chest pain on breathing
  • 81 – Pleurodynia
  • 82 – Intercostal pain
  • 2 – Pelvic and perineal pain
  • 9 – Unspecified abdominal pain

For patients where the pain is caused by a major disease, for instance, “Cancer of the head of the pancreas with increasing cancer pain”, the purpose of the encounter is to evaluate cancer, not manage the pain, so the cancer is coded first. The primary diagnosis is C25.0 (Malignant neoplasm of the head of the pancreas). Code G89.3 [Neoplasm related pain (acute) (chronic)] is listed as a secondary diagnosis.

If the encounter is for pain control rather than to evaluate or treat the condition, then you should code the pain first.

2016 CPT Coding Changes

Though the 2016 CPT book contains no changes to the anesthesia codes, there are several modifications affecting pain management services.

Newly added codes

  • 64461 – Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)
  • +64462 – Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure)
  • 64463 – Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed)

Deleted code

  • 64412 – Injection, anesthetic agent; spinal accessory nerve

Revised codes

  • 64633 – Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT): cervical or thoracic, single facet joint
  • +64634 – Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT): cervical or thoracic, each additional facet joint
  • 64635 – Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT): lumbar or sacral, single facet joint
  • +64636 – Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT): lumbar or sacral, each additional facet joint
 
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