The G391 billing code is used for reporting nonspecific chest pain in medical billing. It is one of thousands of codes in the ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) system used by healthcare providers, insurance companies, and public health agencies across the United States.
What does the G391 code specifically refer to?
The ICD-10-CM code G391 refers specifically to “Chest pain, unspecified”. It is used when a patient reports or experiences chest pain, tightness, pressure, or discomfort but a specific cause for the symptom cannot be determined. This is considered a symptom code, meaning it describes a clinical manifestation versus a diagnosed disease.
When should G391 billing code be used?
The G391 code should be used when:
- A patient reports chest pain but the cause is unknown after evaluation
- Test results are inconclusive for determining an acute cardiac or pulmonary cause
- The symptom is unspecified after workup and the provider cannot definitively diagnose a related illness
This code is most often used in the emergency department when a patient presents with chest pain but a heart attack or other acute condition is ruled out. However, it may also be reported in outpatient settings when chest pain is present but a cause cannot be identified after initial clinical assessment and testing.
When should G391 billing code NOT be used?
G391 should NOT be used if the chest pain can be specifically attributed to a known diagnosis. Some examples include:
- Angina pectoris (use code I20.9)
- Acute myocardial infarction (use code I21.3)
- Pleurisy (use code R07.1)
- Chest wall pain (use code M54.6)
In these cases, the definitive diagnosis code that describes the condition causing the symptom should be reported as opposed to the nonspecific symptom code.
What are common presentations associated with G391?
Some typical clinical presentations that may warrant the use of G391 billing code include:
- Central chest pressure, tightness, or discomfort
- Left-sided, right-sided, or substernal chest pain
- Chest pain with radiation to jaw, neck, shoulder, arm, wrist, or hand
- Chest pain that is reproducible by palpation but no clear etiology
- Chest pain that has anginal features but cardiac workup is negative
The key is that no definitive acute cardiopulmonary process or other diagnosis explaining the pain can be made after clinical evaluation and diagnostic testing as appropriate.
What are “excludes notes” for G391?
There are some conditions that are excluded from being coded as G391 chest pain, unspecified. These are noted under “excludes” notes for the code:
- Chest discomfort (pain) arising from the breast (N64.89)
- Chest pain not otherwise specified (R07.89)
- Chest wall pain (M54.5)
These conditions would either be coded directly using those specified codes or by using a code for the definitive diagnosis responsible for the symptom if known.
Can G391 be coded as a primary or secondary diagnosis?
Yes, G391 can be assigned as either a primary or secondary diagnosis code depending on the clinical circumstances:
- Primary diagnosis – Appropriate when the chest pain is the main reason for the hospital admission or healthcare visit, evaluation reveals no specific cause, and no other diagnoses are known.
- Secondary diagnosis – Appropriate when another condition is primarily responsible for care (e.g. pneumonia) but chest pain requiring evaluation is also present.
What are common comorbidities associated with G391?
Some medical conditions that may be coded alongside G391 as comorbidities or complications include:
- Anxiety disorders
- Gastroesophageal reflux disease (GERD)
- Hypertension
- Coronary artery disease
- History of cardiac surgery or procedures
- Musculoskeletal chest wall disorders
Though these patients may have chest pain, if a definitive causal diagnosis cannot be made, G391 should still be used along with codes for known conditions the patient has.
What are the common CPT codes associated with G391?
Common CPT (Current Procedural Terminology) codes reported with an ICD-10 code of G391 include:
CPT Code | Procedure Description |
---|---|
93000 | Electrocardiogram, routine ECG with at least 12 leads |
93005 | Electrocardiogram, tracing only, without interpretation and report |
93010 | Electrocardiogram, interpretation and report only |
73030 | X-ray exam, chest, single view, frontal |
78465 | Myocardial perfusion imaging; single study |
93880 | Duplex scan of extracranial arteries |
These CPT codes represent common diagnostic tests and evaluations performed to rule out cardiac, pulmonary, and musculoskeletal causes of chest pain.
What is the typical treatment for G391 chest pain?
Treatment for chest pain associated with G391 usually involves:
- Cardiac monitoring and serial ECG testing while in the emergency department
- Pain control with medications like nitroglycerin, opioids, and NSAIDs
- Reassurance and education on symptoms of concern warranting follow up
- Discharge instructions on any medications prescribed and follow up with primary care
- Outpatient stress testing, CT angiogram, echocardiogram if high clinical suspicion
The goals are to rule out acute dangerous causes, treat symptomatic pain, identify underlying medical conditions contributing to symptoms, provide discharge education, and facilitate appropriate follow up care.
What is the typical cost and reimbursement for G391?
The cost and reimbursement for care associated with G391 chest pain depends on the setting, evaluations performed, and specific payer details. Some general statistics on cost include:
- Average emergency room visit cost with chest pain workup: ~$3,500
- Average Medicare reimbursement for G391 as primary diagnosis: ~$425
- Average reimbursement from private insurance for G391: ~$800
More extensive diagnostic testing and imaging will increase the cost and reimbursement. Providers should accurately report medical necessity to support reimbursement.
Conclusion
In summary, G391 is the ICD-10-CM code used to report nonspecific chest pain of unclear etiology after clinical evaluation. It can be used as a primary or secondary diagnosis code. Typical presentations involve chest pressure, tightness or discomfort. Related diagnostic codes cover ECGs, chest x-rays, myocardial perfusion scans and other cardiac workups. Treatment focuses on ruling out acute conditions and symptomatic management. Reimbursement varies based on setting, insurer, and necessity of diagnostic testing. Accurate coding with G391 is important for appropriate reimbursement when a definitive cause for chest pain cannot be determined.