According to sources, healthcare providers and practices need to be careful when using Category 89 codes from ICD-10-CM. These codes are used only in specific conditions and are normally used in combination with other categories and chapters to include complete information regarding chronic pain, neoplasm, and related pain.

Doctors and physicians must not document a code from category 89 for pain management in case the pain isn’t specified, i.e., acute, chronic, neoplasm-related, post-thoracotomy, or post-procedural. Here’s a quick glance through commonly used ICD-10 pain codes.

ICD-10 Codes for Pain Management

The tenth chapter of the International Classification of Diseases has more than 160 codes for pain management and reporting. The official guidelines regarding pain reporting in ICD-10-CM come with detailed instructions for coding pain.

Codes used to represent pain are included in multiple ICD-10 chapters. These include

  • Chapter 6: Diseases of the Nervous System: (G00-G99)
  • Chapter 7: Diseases of the Eye & Adnexa (H00-H59)
  • Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
  • Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)

Following are some of the most commonly used pain codes in ICD-10.

  • G89.0: Central pain syndrome Chronic Condition
  • G89.11‑G89.18 G89.1: Acute pain, not elsewhere classified
  • G89.21‑G89.29 G89.2: Chronic pain, not elsewhere classified
  • G89.3: Neoplasm-related pain (acute) (chronic)Chronic Condition
  • G89.4: Chronic pain syndrome

Understanding Category G89 Codes

The information above shows that category G89 codes stand for acute pain, neoplasm-related pain, and two pain syndrome codes. To assign these codes accurately, the doctor should mention the type of pain troubling the patient.

According to ICD-10-CM guidelines, when the source of pain is known, the doctor must use a code for underlying conditions and not the pain code. In case the purpose of the treatment is to lower the pain, instead of treating the underlying condition, they must assign a pain code with a sequence to start with.

For instance, a patient visits an interventional radiologist for a facet joint injection. Their history suggests degenerative disc disease of the thoracic spine with radiculopathy as the reason for chronic lower back pain.

So, this encounter will be considered for pain control and not for evaluation or treatment of the degenerative disc disease. So, the code for pain will be mentioned first. Here, the main diagnosis will be for G89.29 or other chronic pain, and the secondary diagnosis will be M51.14, specifying intervertebral disc disorders with radiculopathy, thoracic region.

ICD-10-CM coding instructions tell us that doctors can combine G89 codes from other categories/chapters for complete detail regarding acute, chronic, or pain caused by neoplasm. For instance, they can use the G89 code for specifying acute or chronic pain. However, specifying the site of pain first is a must unless the treatment purpose is pain management, for which G89 will be used first.

Don’t Code G89 Just to Get Paid

The ICD-10-CM guidelines are quite clear regarding coding for acute or chronic pain. Healthcare providers must use codes based on the documentation and not those that are reimbursed by the payor. Even the Office of Inspector General (OIG) has talked about it.

Still practices and healthcare specialists are following deceptive practices such as using diagnosis codes that will get them paid instead of using proper codes based on the patient’s condition. 

This bad practice results in compliance issues, damaging the credibility of your practice and may even lead to lawsuits. Hence, always report codes that represent and support the medical record to reflect patient’s diagnosis.

Be Aware of G89.2 Options

According to the Institute of Chronic Pain, chronic pain syndrome is a pain associated with psychosocial dysfunction. Simply put, the pain results in stressful conditions, leading to even more stress and resulting in excessive pain.

To deal with chronic pain, you must be aware of these ICD-10-CM codes.

ICD-10-CM codes for chronic pain Management

  • G89.21 – Chronic pain due to trauma
  • G89.22 – Chronic post-thoracotomy pain
  • G89.28 – Other chronic post-procedural pain
  • G89.29 – Other chronic pain
  • G89.3 – Neoplasm-related pain (may be acute or chronic)
  • G89.4 – Chronic pain syndrome

A good practice to follow here is to make sure you include details of the psychosocial dysfunction experienced by the patient due to chronic pain in the documentation.

How is F11 Different?

Many doctors and practices tend to use F11 (Opioid-related disorders) in documentation for chronic pain. However, if the patient is taking the correctly prescribed medication for pain relief, this code becomes irrelevant.

In case the practice or doctor wants to mention that the patient is on opioids, they can use the ICD-10-CM code Z79.891 as a secondary diagnosis code, which comes next to the G89 code. Z79.891 stands for (Long-term [current] use of opiate analgesic).

Important Factors to Remember When Reporting ICD-10 G89 Pain Codes

Pain Code Sequencing

Assigning and sequencing ICD-10-CM codes for pain management follows encounter notes and the cause for the encounter. When the patient talks about pain and pain alleviation, it must be considered the primary diagnosis, and hence, the G89 code category is sequenced first.

  1. When the encounter visit is based on pain management or pain alleviation, a code from Category G89 will take over. It mentions the condition of the patient and that pain must be listed first. Here, the encounter is all about pain eradication, and not treating the condition causing it.
  2. Conversely, Category G89 codes will not be listed first if the diagnosis is specifically for the underlying condition causing the pain, i.e., spinal fusion. For instance, the underlying condition or the cause of pain is known, and the encounter is to treat the specific condition responsible for pain.

Examples from AAPC

  1. In case the patient visits a clinic for pain alleviation due to acute neck pain from trauma, doctors or physicians must use G89.11 to accurately document Acute pain caused by trauma followed by M54.2 Cervicalgia.
  2. Start by mentioning neoplasm-related pain – acute or chronic – by mentioning G89.3 to show the first diagnosis when the diagnosis is for pain management. Here, the neoplasm condition must be reported as an additional code.

Site-Specific Pain Codes

Another significant thing to remember while documenting or coding pain management-related issues is to identify the site (body part) and source of pain. Category G89 codes are accompanied by codes identifying the pain site. This is done to provide additional information about the type and area of pain.

For instance, the doctor will assign both codes if a code suggests the pain site. However, it doesn’t fully explain whether it is acute or chronic.

Chronic Pain

According to the official guidelines of ICD, there’s no specific time that decides when pain becomes chronic. Section I.C.6.b.4 states that the healthcare provider’s documentation must be considered as a guide to assigning these codes. If a doctor or physician documents a pain as chronic, it must be considered as chronic.

Post-operative Pain

ICD-10-CM’s official guidelines say that routine or expected post-operative pain suffered by the patient right after the surgery must not be coded. The pain associated with a specific post-operative complication must only be assigned the correct pain code from category G89 – pain not elsewhere classified. Below are the four post-operative codes used for documentation.

  • G89.12 Acute post-thoracotomy pain
  • G89.18 Other acute post-procedural pain
  • G89.22 Chronic post-thoracotomy pain
  • G89.28 Other chronic post-procedural pain

Patients may suffer from acute or chronic pain due to multiple complications arising post-operation. These include post-operative infection, a complication arising like a foreign body left inside during a procedure, and complications arising during implants, grafts, and prosthetic devices. 

Here, the person responsible for coding must review the patient history to establish a cause-and-effect relationship, the complication, and the pain.

If the coder determines that a procedure complication is responsible for the post-operative pain, then the primary diagnosis is the complication. An appropriate code from category G89 will be used to report a secondary diagnosis to show whether the pain is acute or chronic.

Neoplasm Related Pain

Neoplastic processes such as tumor compressing or infiltrating tissue, treatments, and diagnostic procedures, as well as hormonal imbalance causing changes in skin and nerve or immune response, can cause pain. 

Suppose the treatment procedure is intended to lower the neoplasm pain. The biller will assign G89 as the primary code to go along with the neoplasm code as the secondary diagnosis code.

Final Say…

Running a pain management practice and handling relevant coding can be tough for healthcare providers. Especially, when they spend most of their productive hours delivering quality care to those in need. They’re under immense pressure to look after the patients and accurately document the nature of a patient’s medical condition combined with diagnostic services to counter the condition.

It can compromise their primary job which is not ideal for them and the patients trusting them with quality healthcare and diagnosis. This is where a leading medical billing services provider like I-Med Claims comes into play. Our experienced medical billers and coders are acquainted with insurance guidelines and well-versed in category G89 – pain management billing and coding.

They’re familiar with the technicalities involved in documentation, billing, charge capture, accurate coding, and claim submission for all possibilities. Be it acute pain, chronic pain, neoplasm pain, post-operative pain, pain management, or treating the underlying condition; we can do it with ease to ensure every bill gets approved and your practice enjoys high revenue.