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Coding and Sequencing of Neoplasm-Related Pain

Coding and sequencing of neoplasm-related pain is based on the medical documentation and the ICD-10-CM coding guidelines.

woman in pain due to cancer to go along with coding and sequencing of neoplasm related pain.

Name That Code!

Question: A 58-year-old female patient presents with malignant neoplasm of the left breast. She is seen to control the severe pain due to the malignancy. Assign the first-listed or principal diagnosis code.

Answer:

G89.3, Neoplasm related pain (acute) (chronic)

Documentation indicates that the pain is related to the neoplasm, and the reason for the encounter is for pain management.

Coding Guidelines

According to the ICD-10-CM Coding Guidelines, “Code G89.3 is assigned to pain documented as being related, associated, or due to cancer, primary or secondary malignancy, or tumor. This code is assigned regardless of whether the pain is acute or chronic.”

Code G89.3 should be assigned as the principal or first-listed code when the reason for the encounter is for pain management. The underlying neoplasm should be reported as an additional diagnosis.

The guidelines further state, “When the reason for the admission/encounter is management of the neoplasm and the pain associated with the neoplasm is also documented, code G89.3 may be assigned as an additional diagnosis. It is not
necessary to assign an additional code for the site of the pain.”

Locate and Verify

In the ICD-10-CM Alphabetic Index, see Pain(s)/due to cancer G89.3. Verified in the Tabular, our correct code is G89.3, Neoplasm related pain (acute) (chronic).

Inclusion terms listed under G89.3 include:

  • Cancer associated pain
  • Pain due to malignancy (primary) (secondary)
  • Tumor associated pain

Therefore, whichever of the above terms are used in the documentation, they are reported with G89.3.

Secondary Diagnosis

Although we are not asked to code for the secondary diagnosis in this coding exercise, guidelines indicate the underlying neoplasms should also be coded after G89.3 when the admission/encounter is documented as pain control/pain management.

In the ICD-10-CM Table of Neoplasms, see Breast (connective tissue) (glandular tissue) (soft parts)/malignant primary C50.9-. When we go to the Tabular, we can verify our correct code as C50.912, malignant neoplasm of unspecified site of left female breast.

image of woman in pain due to malignant neoplasm and how to code for it in ICD-10-CM

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