Part B Insider - 2016 Issue 4
You Be the Coder: Choosing Acute or Chronic Dx
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Article Overview
This educational coding article explains the general differences between acute and chronic pain and shows how those distinctions affect ICD-10-CM diagnosis selection for an established-patient office encounter. It is aimed at coders and billing staff who need a better understanding of pain-related documentation review, diagnosis specificity, and when additional physician clarification may be needed before claim submission.
Why This Topic Matters
Pain-related diagnoses are often documented nonspecifically, so coders need to recognize when the chart supports additional detail and when a query is appropriate. This article matters because it frames the documentation review process around common pain categories and the ICD-10-CM codes associated with them.
Article Sections
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Question
Introduces a coding question about pain as the diagnosis for an established-patient office visit. The section frames the documentation concern that drives the rest of the article.
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Answer
Provides general guidance on reviewing documentation for additional specificity before selecting a diagnosis code. The section also situates the discussion in the context of an established-patient evaluation and management service.
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Acute pain basics
Summarizes broad clinical characteristics associated with acute pain and contrasts them with later discussion of chronic pain. This section sets up the coding categories that follow.
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Acute pain ICD-10 codes
Lists the ICD-10-CM pain-related codes associated with acute pain in the article. The section provides code references for this pain category.
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Chronic pain basics
Summarizes broad clinical characteristics associated with chronic pain and notes that pain may or may not have a clearly identified source. This section introduces the chronic pain coding category.
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Chronic pain ICD-10 codes
Lists the ICD-10-CM pain-related codes associated with chronic pain in the article. The section provides code references for this pain category.
What You Will Learn
- How the article distinguishes acute pain from chronic pain at a high level
- What documentation issues can affect pain diagnosis selection
- Which ICD-10-CM pain-related code groupings are referenced in the article
- Why additional chart review or physician clarification may be necessary for pain diagnoses
Who Should Read This
- Medical coders
- Billing staff
- Coding auditors
- Physician practice staff
Codes Discussed
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