Other chronic post-operative pain:  ICD-9-CM Code  338.28

(Note: BWC to indicate body part/region in narrative for code)

 

Definition:  

 

Ongoing pain symptoms of at least 12 months duration post completion of a definitive surgical procedure other than thoracotomy (338.22) or lumbar discectomy, laminectomy or fusion (722.8) for a recognized allowed condition in the claim. Medical records must indicate that pain is primary factor limiting performance of activities and focus of medical care is toward controlling/relieving pain.  Medical records should document there has been ongoing medical care and attempts to identify and treat the source of pain.  Such attempts should include appropriate diagnostic studies and consultations.

 

Note:  This diagnosis is a secondary diagnosis of ongoing symptoms after completion of surgical treatment in an individual who has undergone a surgical procedure and is significantly limited due to pain believed to be the result of the procedure.

 

Subjective:

 

·         Symptoms of pain of varying nature, intensity, and character localized to the body region of the primary allowed condition for which the surgical procedure was performed.

·         Treatment must be shown to have been present at least 12 months following completion of the last surgical treatment.

·         May have other symptoms such as but not limited to referred pain, weakness, decreased movement, etc. 

·         Symptoms including pain should not involve multiple sites such as polyarthralgias, fibromyalgia, or systemic connective tissue diseases.

 

Objective:

 

·         None specific.  Diagnosis is for chronic symptom of pain.

 

Diagnostic Tests:

 

·         Diagnostic studies and medical records show prior surgical procedure and absence of more specific diagnosis to explain painful condition such as recurrent herniated disc, RSD, osteoarthritis, etc.