ICD-10 Coding for Chronic Pelvic Pain(R10.2, G89.21)
Complete ICD-10-CM coding and documentation guide for Chronic Pelvic Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Chronic Pelvic Pain
R10-R19Primary Range
Symptoms and signs involving the digestive system and abdomen
This range includes codes for abdominal and pelvic pain, which are relevant for chronic pelvic pain.
Noninflammatory disorders of female genital tract
This range includes codes for conditions like endometriosis, which can be a cause of chronic pelvic pain.
Pain, not elsewhere classified
This range includes codes for chronic pain syndromes, which are relevant for documenting chronic pelvic pain.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R10.2 | Pelvic and perineal pain | Use when documenting pelvic pain without a specific underlying condition. |
|
| G89.21 | Chronic pain syndrome | Use when the primary reason for the encounter is pain management. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for chronic pelvic pain
Essential facts and insights about Chronic Pelvic Pain
Primary ICD-10-CM Codes for chronic pelvic pain
Decision Criteria
clinical Criteria
- Pain lasting more than 3 months with significant impact on daily activities.
Applicable To
- Pelvic pain
- Perineal pain
Clinical Validation Requirements
- Pain localization diagram in chart
- Negative pregnancy test (if applicable)
- Ruling out acute conditions via documentation of: 'No fever/chills', 'Normal CBC/CRP', 'Negative urinalysis'
Code-Specific Risks
- Risk of under-documenting the chronicity of the pain.
Coding Notes
- Ensure documentation specifies the chronic nature of the pain.
G89.21 - Chronic pain syndrome
Use when the primary reason for the encounter is pain management.
Applicable To
- Chronic pain
Excludes
- Acute pain (G89.1)
Clinical Validation Requirements
- Pain diary spanning ≥3 months
- Failed ≥2 treatment modalities documented
- Multidisciplinary care team involvement
Coding Notes
Sequence first if the encounter is for pain management.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic pain syndrome
G89.21Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Chronic Pelvic Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R10.2.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document pain duration and impact on daily activities.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Ensure chronic pain is documented with G89.21 if applicable.
Impact
Incorrect sequencing of chronic pain codes.
Mitigation Strategy
Ensure G89.21 is sequenced first for pain management encounters.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Chronic Pelvic Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Chronic Pelvic Pain
Use these documentation templates to ensure complete and accurate documentation for Chronic Pelvic Pain. These templates include all required elements for proper coding and billing.
Chronic Pelvic Pain Management
Specialty: Pain ManagementRequired Elements
- Pain Characteristics
- Functional Impact
- Treatment Response
- Multidisciplinary Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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