Sequencing of chronic pain and acute pain at different sites

[KimH_178]

I have a PT visit where the assessment is "Right hip pain and chronic low back pain" and I am unsure of how to sequence this. Which of the following would be correct?

1) M25.551
G89.29
M54.50

2) M25.551
M54.50
G89.29

3) G89.29
M25.551
M54.50

4) G89.29
M54.50
M25.551

 

[LisandraP_93966]

3)

• G89.29 is the code for Other chronic pain, which is the primary reason for the visit.
• M25.551 is the code for Pain in right hip.
• M54.50 is the code for Low back pain, unspecified.

 

[NatalieR_91162]

Go to icd 10 guidelines chapter 6.b.1
Disease of nervous system pain category

 

[Laureen Jandroep]

https://www.cco.academy/c/public-discussion/sequencing-of-chronic-pain-and-acute-pain-at-different-sites

The correct sequencing depends on the documented reason for the encounter. If this PT visit is for evaluation/treatment of the specific pain sites (right hip and low back), not for generalized “chronic pain management,” then option 2 is the best choice: M25.551, M54.50, G89.29.

Key guideline points​

• ICD-10-CM guidelines state that when the encounter is for a condition identified by a site-specific pain code (e.g., hip pain, low back pain), the site-specific pain code is sequenced first, with a G89 chronic pain code added if it provides additional information about chronicity.
• When the encounter is specifically for pain control or pain management (for example, a pain clinic visit focused on managing chronic pain itself), a G89 chronic pain code is sequenced first, followed by the site-specific pain code(s).

Applying to this scenario​

• M25.551 = Pain in right hip, which directly reflects “right hip pain.”
• M54.50 = Unspecified low back pain, which reflects “chronic low back pain” when the provider has not linked it to a more specific cause.
• G89.29 = Other chronic pain, which provides the additional detail that the pain is chronic, but does not specify the site.

For a typical PT evaluation/treatment visit where the focus is on the hip and low back pain as the presenting conditions (rather than global chronic pain management), the correct sequencing is:

• Primary: M25.551 (Pain in right hip)
• Secondary: M54.50 (Low back pain, unspecified)
• Additional: G89.29 (Other chronic pain)

That corresponds to option 2. You would only move G89.29 to the first-listed position (options 3 or 4) if the documentation clearly supports that the primary reason for the encounter is chronic pain management rather than treatment of the specific hip and low back pain sites.

See ICD‑10‑CM Official Guidelines, Section I.C.6.b (Pain – Category G89), especially I.C.6.b.1 for sequencing rules and I.C.6.b.4 for chronic pain.

This was answered with the help of AI but I vetted and tweaked the answer a bit and agree.