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2025 ICD-10-CM code G89.28

Chronic pain that follows a surgical procedure (other than a thoracotomy) and persists for more than three months.

Use this code only for chronic pain (lasting more than three months) following surgical procedures other than thoracotomy.

Medical necessity is established by the presence of chronic pain that significantly impacts the patient's quality of life and functional abilities.

Diagnosis and treatment are typically managed by the surgeon or a pain management specialist.

In simple words: This code describes long-lasting pain (more than 3 months) that occurs after surgery, except for surgery on the chest wall. The pain can be mild or severe, and may include numbness or loss of feeling around the area where the surgery was performed. It can be caused by inflammation or damage to tissues during the operation. Doctors diagnose this based on the patient's surgical history, symptoms, a physical exam, and sometimes tests like blood work, X-rays, CT scans, or ultrasounds.

Other chronic postprocedural pain refers to pain that continues for more than three months after any surgical procedure, excluding thoracotomy. This condition can arise from inflammation or the severing of bones, joints, muscles, or nerves during the surgical process. The severity of postprocedural pain varies depending on the surgical site, ranging from mild to severe. Patients typically experience pain, numbness, and sensory loss at or near the incision site. Occasionally, pain can also result from surgical complications. Diagnosis is based on surgical history, symptoms, physical examination, and diagnostic tests such as blood tests, X-rays, CT scans, or ultrasounds of the affected area. Treatment options include over-the-counter NSAIDs for mild to moderate pain and prescription opioids for severe pain.

Example 1: A patient experiences persistent pain in their abdomen six months after an appendectomy., A patient reports ongoing numbness and tingling in their leg four months after knee surgery., A patient has chronic pain at the incision site following hernia repair surgery that lasts for over a year.

Documentation should include the type of surgery performed, date of surgery, location and characteristics of the pain, duration of pain, and any other associated symptoms. Diagnostic tests performed and treatments provided should also be documented.

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