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Note: The system is coded whose abnormal functioning produces the pain, e.g., claudication = vascular.
Similarly, the nervous system is to be coded only when a pathological disturbance in it produces pain.
Thus pain from a pancreatic carcinoma = gastrointestinal; pain from a metastatic deposit affecting bones
= musculoskeletal.
* To be coded for psychiatric illness without any relevant lesion.
Axis III: Temporal Characteristics of Pain: Pattern of Occurrence
Not recorded, not applicable, or not known
Single episode, limited duration (e.g., ruptured
aneurysm, sprained ankle)
Continuous or nearly continuous, nonfluctuating
(e.g., low back pain, some cases)
Continuous or nearly continuous, fluctuating
severity (e.g., ruptured intervertebral disc)
Recurring irregularly (e.g., headache, mixed type)
Recurring regularly (e.g., premenstrual pain)
Paroxysmal (e.g., tic douloureux)
Sustained with superimposed paroxysms
Other combinations
None of the above
0
1
2
3
4
5
6
7
8
9
.2
.3
.4
Severe
-I month to 6 months
-more than 6 months
.5
.6
.0
-1 month or less
.7
-1 month to 6 months
-more than 6 months
.8
.9
* Decide the time at which pain is recognized retrospectively as having started, even though the pain may
occur intermittently. Grade for intensity in relation to the level of current pain problem.
Axis V: Etiology
Genetic or congenital disorders (e.g., congenital dislocation)
.01
Trauma, operation, burns
.01
Infective, parasitic
.02
Inflammatory (no known infective agent), immune reactions
.03
Neoplasm
.04
Toxic, metabolic (e.g., alcoholic neuropathy, anoxia, vascular, nutritional, endocrine), radiation .05
Degenerative, mechanical*
.06
Dysfunctional (including psychophysiological)
.07
Unknown or other
.08
Psychological origin (e.g., conversion hysteria, depressive hallucination).
.09
Note: No physical cause should be held to be present, nor any pathophysiological mechanism
* For example, biliary colic or lumbar puncture headache would be mechanical.
For example, migraine, irritable bowel syndrome, tension headache. Note: Include syndromes where a
pathophysiological alteration is recognized. Emotional causes may or may not be present.
Examples:
Mild postherpetic neuralgia of T5 or T6
6 months duration
303.22e
033.97c
765.07
In the case of spinal and radicular pains, the additional suffixes S and R are used. Where one is used it
indicates that only spinal or only radicular pain is evident. Where both additional suffixes might be used
because both phenomena are present, the letter C (for Combined spinal and root pain) is preferred. Many
spinal codes will be usable with radicular codes. A few spinal codes theoretically should never give rise to
radicular pain, e.g., fracture of a spinous process. A number more rarely give rise to radicular pain but
theoretically could do so, e.g., infection of a vertebral body. In these circumstances the R codes have been
provided for relative completeness but will rarely, if ever, be required.
Note: X = to be completed individually in each case
If there is no code:
(a)
check the introduction to see if the item has been rejected, e.g., atypical facial pain;
(b)
construct your own code or use the miscellaneous category 99X.X8; or
(c)
code as undiagnosed: X9X.X8.
Note that construction of a new code will require a complete challenge because of the existence of many
possible overlapping codes. The editors will be pleased to advise on the possibility of assistance in this
respect.
The first part of the list of topics and codes follows. The second part begins on p. 17 after the discussion
on radiculopathy.