Being a medical coder, I always have a lot of problems with ICD 10 codes. The major confusion occurs with coding acute and chronic condition. We have some specific coding guidelines for coding acute and chronic conditions, first let us understand their definition.

Acute means having rapid onset, severe symptoms, and a short course

Chronic means of long duration; denotes a disease showing little change or slow progression

In ICD 10 codebook we have separate coding guidelines for coding acute and chronic condition, when documented together. Below is the ICD 10 coding guidelines,

“If the same condition is described as both acute (subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) code first”

Providers treating acute or chronic pain are required to document the severity of a person’s pain. Pain scales were developed for this purpose. A patient will be asked if he or she is in pain and, if so, what is the level of discomfort. Pain is measured on a scale such as from 1 to 10, or a series of images depicting a face in no pain or excruciating pain, with 10 as the most severe pain. The pain being evaluated may be acute, such as postoperative pain, or chronic, such as from osteoarthritis.

Table of Contents

When to use G89 category codes

Pain has both physical and psychological components and may be acute or chronic in nature. It is often the symptom of another condition. Chronic pain complaints include headache, low back pain, cancer-related pain, arthritis, and pain resulting from nerve damage (neurogenic).

Many pain complaints, such as abdominal pain (R10.9) or back pain (M54.9), are reported with codes from chapters other than the nervous system. This lesson specifically addresses pain codes reported from category G89, Pain, Not Elsewhere Classified from Chapter 6.

Category G89 codes are used to give more information about acute or chronic pain.

The determination of whether the pain is acute, chronic, or chronic pain syndrome is dependent on the provider’s documentation. There is no time frame defining when pain becomes chronic.

The coder should not report G89 category codes until the pain is not specified as acute or chronic, postthoracotomy, postprocedural, or neoplasm-related

The use of these codes on a claim may provide additional detail and help justify treatment, the need for specialized pain management consultation, and other factors, such as length of stay or severity of illness. Routine or expected postoperative pain immediately after surgery should not be coded.

The provider’s documentation should be used to guide the coding of postoperative pain.

There are other conditions as well which are used frequently like sinusitis, fractures etc. For coding unspecified sinusitis, it will lead directly to chronic sinusitis as per ICD 10 codebook. Here, the documentation should clearly mention “acute sinusitis” for coding acute ICD 10 code, otherwise the coder should report only the chronic sinusitis ICD 10 code.

Chronic fracture leads to pathological fractures, which are also called as non-traumatic fractures. In old age the bone density decreases, hence the possibility of causing fracture increases even without any injury.

When to use of G89 codes as primary and secondary

G89 codes are majorly used in pain control or pain management procedures. Sequencing of G89 codes totally depends on the reason for encounter or admission.

When the exam is totally focused towards pain management or the reason for encounter is for pain control or pain management, then the underlying pain should be reported as primary diagnosis followed by the cause of pain.

If the encounter is only for pain management or pain control, the code from G89 should be reported as primary diagnosis.

When the encounter is for any other reason except for pain management or pain control, then assign the normal pain code as primary followed by additional diagnosis code from G89 category.

Present on Admission Reporting Guidelines

Acute and Chronic Conditions

Assign “Y” for acute conditions that are present at time of admission and N for acute conditions that are not present at time of admission.

Assign “Y” for chronic conditions, even though the condition may not be diagnosed until after admission.

If a single code identifies both an acute and chronic condition, see the POA guidelines for codes that contain multiple clinical concepts.

Acute and chronic cervicitis : Here their is a combine code for both acute and chronic, hence N72 will only be reported.

Cervicitis (acute) (chronic) (subacute) N72

Acute and chronic appenditis: For conditions which has separated acute and chronic diagnosis codes, then acute and chronic conditions can be coded together with acute sequenced first.

K35.80, K36

When a chronic condition requires care or monitoring during the stay, a code for that condition can be assigned as an additional code. Codes for chronic conditions that do not affect the stay are not assigned.

References:

http://www.hcpro.com/HIM-239658-865/

https://codingstrategies.com/news/

https://www.icd10monitor.com/