Internal Medicine Coding Alert

Question: What are the guidelines for differentiating between peripheral and autonomic neuropathy, and coding appropriately?

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Answer: Without specific information contained in the patient's chart, directing you to the correct code would be difficult. These neuropathies have a great deal of overlap.

Key: Select the correct ICD-9 code by reviewing the definitions below from the Mayo Clinic, and comparing them to the provider's documentation. The code range for peripheral neuropathy is 337.xx. The code range for autonomic (poly)neuropathy is 357.x. If the neuropathy is secondary, report the primary or underlying disease causing the neuropathy or polyneuropathy first on the claim.

Peripheral: Peripheral neuropathy often causes numbness and pain in the hands and feet. People typically describe the pain of peripheral neuropathy as tingling or burning. Peripheral neuropathy is caused by nerve damage. It can result from such problems as traumatic injuries, infections, metabolic problems, and exposure to toxins. One of the most common causes is diabetes.

In many cases, peripheral neuropathy symptoms improve with time -- especially if the symptoms are caused by an underlying condition that can be treated.

Autonomic: Autonomic (poly)neuropathy is a type of peripheral neuropathy that affects involuntary body functions, including heart rate, blood pressure, perspiration, digestion, and other processes. Instead of a specific disease, autonomic neuropathy refers to damage to the autonomic nerves that result in a variety of signs and symptoms.

Autonomic neuropathy can be a complication of several diseases and conditions. Signs, symptoms, and treatment vary widely depending on the cause, and on which nerves are affected.

A large number of diseases and conditions can cause autonomic neuropathy,including alcoholism, autoimmune diseases, diabetes, and treatment with some chemotherapy and anticholinergic drugs.

Resource: For a more in-depth treatment of these two disorders, go to www.mayoclinic.com/health/peripheral-neuropathy/DS00131 and www.mayoclinic.com/health/autonomic-neuropathy/DS00544.

-- Answers to You Be the Coder and Reader Questions were reviewed by Bruce Rappoport, MD, CPC, CHCC, a board-certified internist and medical director of Broward Health's Best Choice Plus and Total Claims Administration in Fort Lauderdale, Fla.