Freeze Out Chronic Pain Symptoms

Tue, Feb 9, 2016 --

CPT Codes, ICD-10

chronic pain codes, medical coding for acute and chronic pain, pain management codes, chronic pain coding guidelines, coding guidelines for pain, syndrome icd10 codes

Pain — this is a concept everyone understands. Acute pain, that stabbing, sudden sensation alerting us to possible injury or serious illness, is a normal sensation. But when does pain become chronic pain? The National Institutes of Health defines chronic pain as any pain that lasts more than 12 weeks. People develop chronic pain after an initial injury like a back sprain, or they might experience chronic pain because of an ongoing illness such as cancer. On the other hand, sometimes chronic pain has no clear cause.

ICD-10 Keeps Acute and Chronic Pain ‘In the Family’

ICD-10’s G89.- (Pain, not elsewhere classified) category is a “family” of codes that covers both acute and chronic pain. A few of the codes you’ll see here include the following:

  • G89.0 — Central pain syndrome
  • G89.11— Acute pain due to trauma
  • G89.21— Chronic pain due to trauma.

This family contains broad codes that you don’t report if a definitive diagnosis is established, unless the encounter is specifically for pain control, rather than management of the underlying condition.

Freezing the Pain With Cryoablation

Pain management physicians use cryoablation and radiofrequency lesioning procedures to help manage chronic pain. Cryoablation, also called cryoanalgesia, destroys nerves with exposure to extreme cold. The major advantage to this procedure is the absence of neuritis or neuroma formation. Cryoablation provides prolonged pain relief, or analgesia, with effects that are reversible, with no systemic side effects and minimal tissue damage. The results of this outpatient procedure typically last about six to 12 months.

Some conditions that may benefit from cryoablation include:

  • Thickening of the sheath surrounding the nerves leading to the toes, also called Morton’s neuroma (G57.6-, Lesion of plantar nerve …)
  • Pain in the tailbone, also called coccydynia (M53.3, Sacrococcygeal disorders, not elsewhere classified)
  • Pain in lateral femoral cutaneous nerve, with tingling, numbness and burning pain in the outer thigh (G57.1-, Meralgia paresthetica), with the fifth character indicating right or left.

Burning Out Pain With Radiofrequency Lesioning

Because radiofrequency lesioning carries more side effects and causes nerve destruction, physicians and many payers consider this a more extreme treatment modality to be turned to after other more conservative measures have failed. It can be useful in treating trigeminal neuralgia, pain in the dorsal root ganglion, and in the facet joints. For example, the payer Anthem spells out a lengthy list of criteria that must be met to consider radiofrequency lesioning medically necessary. These include severe pain that limits activities of daily living for at least three months, despite documented treatments that are more conservative, including physical therapy, activity modification, weight loss, and drug therapy.

From a coding standpoint, with radiofrequency lesioning procedures you must also consider National Correct Coding Initiative (NCCI) edits, which bundle some procedures with others that they are usually performed with. For example, fluoroscopic or CT imaging is included in 64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint).

What About You?

Have any tips to share about chronic pain coding? Let us know in the comment box below. We love to hear from you!

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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