Neurology & Pain Management Coding Alert

A new code will finally allow neurologists to specify a diagnosis of muscle weakness diagnoses. Now if a patient presents to your practice complaining of muscle weakness, your only choice is to report the code for unspecified disorder, 728.9 (Unspecified disorder of muscle, ligament and fascia). For 2004, however, you may assign the new code 728.87 (Muscle weakness), which more accurately describes the patients condition.

 Most physicians are unsure of what unspecified codes such as 728.9 include, says Mary J. Brown, CPC, CMA, specialist at OrthoWest PC, a seven-physician practice in Omaha, Neb. More descriptive ICD-9 codes like 728.87 help paint a picture for your insurer, and that can save time by staving off unnecessary denials and appeals.

 Note: CMS has not deleted 728.9, and you may still assign this code for other muscle, ligament and fascia conditions that the more specific codes do not describe.

Go Ahead, Abbreviate the Difficulty-Walking Code
 
  If you report 719.7x (Difficulty in walking) today without adding a fifth digit to describe the site, your carrier will most likely deny the claim for a truncated diagnosis code. ICD-9 2003 dictates that this code is invalid without a fifth digit. But in 2004, that will no longer be the case.

 Effective Oct. 1, 2003, CMS will delete codes 719.70 and 719.75-719.79, and replace them with the four-digit code 719.7, still described as difficulty in walking. The new code is a bit less specific because it no longer includes the site specifications, but it will be useful for those patients who only suffer from difficulty walking (such as due to neurological problems) and not because of specific joint conditions, Brown says.

 If your patient has specific joint pain, you should bypass 719.7 and continue to report the 719.4x series, which specifies pain in joint, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.

Report Concussion More Precisely

 Soon youll be able to report concussion diagnoses with more precision. CMS has deleted the general code 850.1 (Concussion, with brief loss of consciousness) and replaced it with the more specific codes 850.11 (Concussion, with loss of consciousness of 30 minutes or less) and 850.12 (Concussion, with loss of consciousness from 31-59 minutes).

 Additional changes relevant to neurology include:

  331.11 Picks disease
  331.19 Other frontotemporal dementia
  331.82 Dementia with Lewy bodies
  348.30 Encephalopathy, unspecified
  348.31 Metabolic encephalopathy
  348.39 Other encephalopathy
  358.00 Myasthenia gravis without (acute) exacerbation
  358.01 Myasthenia gravis with (acute) exacerbation
  728.88 Rhabdomyolysis
  780.93 Memory loss
  781.94 Facial weakness
  V65.19 Other person consulting on behalf of another person.

 CMS published its list of approximately 100 new and revised ICD-9 (diagnosis) codes in the May 19 edition of the Federal Register (Table 6A, p. 27353). The codes have already undergone a public comment period and will be included in the next edition of the ICD-9 manual, to go into effect Jan. 1, 2004.