Pain Codes in ICD-10-CM

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
March 27th, 2019

When coding with ICD-10-CM, pain codes can be found in different sections:

abdomen pain (R10.-)
back pain (M54.9)
breast pain (N64.4)
chest pain (R07.1-R07.9)
ear pain (H92.0-)
eye pain (H57.1)
headache (R51)
joint pain (M25.5-)
limb pain (M79.6-)
lumbar region pain (M54.5)
pelvic and perineal pain (R10.2)
shoulder pain (M25.51-)
spine pain (M54.-)
throat pain (R07.0)
tongue pain (K14.6)
tooth pain (K08.8)
renal colic (N23)
pain disorders exclusively related to psychological factors (F45.41)

Chronic Pain is a condition that can be diagnosed on its own or diagnosed as a part of another condition. 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 the use of these 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.

According to Section: 1;C.6.b, "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:

The following codes are the most common pain codes used in ICD-10-CM

G89.0                     Central pain syndrome   Chronic Condition

G89.11G89.18      G89.1 Acute pain, not elsewhere classified

G89.21G89.29      G89.2 Chronic pain, not elsewhere classified

G89.3                     Neoplasm related pain (acute) (chronic) Chronic Condition

G89.4                     Chronic pain syndrome

There are more specific pain codes that define the encounter with more specificity, such as acute and chronic. Chronic Pain has no time frame defining the pain and can be reported when the condition is chronic pain.

Review the guidelines to understand when assigning pain as a symptom and when G codes are acceptable as the first listed diagnosis.

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 the management of the underlying condition.

If the pain is not specified as acute or chronic, post-thoracotomy, postprocedural, or neoplasm-related, do not assign codes from category G89.

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.

G89.3 May be assigned as the first listed diagnosis or the principal diagnosis when the reason for the encounter is neoplasm related pain.

Pain Codes in ICD-10-CM. (2019, March 27). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/pain-codes-in-icd-10-cm-34880.html

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