Revised and Improved Coding and Classification System for Chronic Pain

Pain diagnoses have never been represented systematically in international diagnostic coding systems, including the International Classification of Diseases (ICD). Since there is no coding structure for chronic pain, it is difficult for hospitals to charge for treatment, and it is almost impossible for insurers and other policymakers to properly grasp the human and financial consequences of chronic pain. However, all of that is going to change with the recent coding changes.

The New ICD-11 Codes

The revised 11th edition of the ICD (ICD-11), which was accepted by the World Health Assembly in May 2019, provides a coding and grading system for chronic pain for the first time in history. The healthcare system gains an interesting new ability to quantify the frequency, prevalence, and effect of chronic pain, both alone and in tandem with comorbidities, by putting ICD-11’s new coding system in the hands of primary care providers (PCPs), who are increasingly responsible for treating the vast majority of patients dealing with chronic pain.

According to Blair H. Smith, MD, a member of the IASP Task Force for the Classification of Pain, the new code for chronic primary pain is particularly innovative because it allows “doctors to recognize chronic pain as a distinct clinical entity, even when an underlying pathology is not evident. This gives validity to a condition that was previously at risk of going unnoticed and thus being evaluated and treated insufficiently.”

Coding for Chronic Pain

ICD-11 describes chronic pain as pain that persists or lasts more than three months. This category of pain will be coded with seven key codes under the current classification, plus a new code for “chronic primary pain,” of which chronic pain is the disorder. The other six major codes are for chronic secondary pain syndromes, such as cancer-related pain, post-surgical/post-traumatic pain, neuropathic pain, secondary headache or orofacial pain, secondary abdominal pain, and secondary musculoskeletal pain, which all occur in the sense of another illness.

The World Health Organization introduced two more codes that recognize any pain disorders that don’t fall with the seven main codes. It also includes those for “any specified chronic pain,” which is only to be used where a new collection of diseases is identified as causing chronic pain. Another is for “chronic pain, unspecified,” which happens when it’s unknown if the pain is primary or secondary.

How Will it Change Daily Primary Practice?

The direct way chronic pain can be coded under the current ICD-11, which is scheduled to go through effect in January 2022, will make it easier for clinicians to apply the codes in primary care settings, where medical consultations are routine and frequently all too brief. Providers had to code dynamically to incorporate pain symptoms into current symptom-based codes, diagnostic labels, or treatment-based codes in older coding systems.

The new system will allow patients’ conditions to be coded based on what they are instead of how they are being treated. For example, using the ICD-10 code for “opioids and related analgesics and chronic postsurgical pain.”

The creation of a standardized classificatory language relating to chronic pain disorders can significantly improve the treatment of people dealing with chronic pain, in addition to simplifying the implementation of ICD-11 at the primary care level. First and foremost, the addition of these new codes highlights the importance of chronic pain as a primary care condition, which can help to reduce the stigma associated with pain.

By changing the emphasis of identifying a cause for the pain to managing the pain earlier in the patient’s journey, the “chronic primary pain” code can reduce unnecessary procedures and diagnostic exams. The use of the six secondary pain syndrome codes, on the other hand, can help in recognizing patients at high risk of developing complex chronic pain and matching them to appropriate specialists and/or evidence-based treatment pathways sooner than later.

Benefits of the ICD-11 Integration

The use of the new codes would enhance the healthcare system’s ability to assess the frequency, prevalence, and effect of chronic pain. plus it also helps improve chronic pain treatment. As a result, it will be easier to define the human, monetary, and academic needs for treating chronic pain to further improve the quality of care. Increased awareness of chronic pain as a widespread problem may contribute to better undergraduate, graduate, and professional education and gateway to new studies. Insurers can also appreciate a coding system that includes details that can be used to direct care provision and payment, improved clinical quality and timing, and measure improvements across time and countries.

Dr. Smith’s co-authors, Dr. Antonia Barke and Beatrice Korwisi are keen to find out that each country must first accept and then enforce the new coding system before the new pain codes can be used for routine care. With that caveat in mind, Dr. Egil A. Fors, another of Smith’s co-authors, said, “The introduction and use of ICD-11 classification in primary care could, in principle, be very soon,” as “…some centers in Norway, Thailand, and Japan have already started to classify chronic pain according to ICD-11 in specialist care.”

The new coding system for chronic pain in the updated ICD-11 is easy and detailed, and it was developed with primary care practitioners in mind. The machine’s use can boost pain relief immediately, but its real effect will be felt over time as chronic pain issues — and their human and financial impacts — are finally assessed in such a manner that targeted changes in service quality and payment processes can be made across the entire healthcare system.

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