Neurology & Pain Management Coding Alert

"Two distinct problems may plague professional coders who face the challenge of assigning proper codes during electroencephalographic (EEG) seizure monitoring, which include archaic diagnostic definitions and neglecting to code for signs and symptoms.

1. Archaic diagnostic definitions often frustrate coders who may be struggling to match the current medical terminology used by physicians in the patient record with the description published in the ICD-9 manual. Coders can mitigate this frustration by acknowledging the limitations of current diagnostic descriptionsparticularly within the series of epileptic seizure codesand assigning general ICD-9 codes that describe less specific types of seizure activity when appropriate.

2. Neglecting to code signs and symptoms and instead relying only on the final diagnosis may result in diminished reimbursement levels. Coders can counter this by remembering that the Health Care Financing Administration (HCFA) has ruled that it is acceptable for physicians to report signs and symptoms when the final diagnosis is not definite.

Using Epilepsy and General Convulsion Codes

Patients who suffer from seizures undergo EEG monitoring to pinpoint the reasons for the events and to help neurologists localize the portion of the brain affected. Under these circumstances, two of the most common codes used to describe seizures during EEG monitoring are 780.39 (other convulsions) or 345.9 (epilepsy, unspecified).

Generally, 780.39 is assigned to seizure activity that cannot be classified as epilepsy. If the patient suffers from epilepsy, however, there are several codes within the 345 series that may be appropriate.

Nonetheless, when you look at the diagnosis codes for epileptic seizures, it is very clear that they are completely out of synch with the manner in which modern epileptologists describe these symptoms, notes Robert J. Gumnit, MD, president of the National Association of Epilepsy Centers, which represents the largest comprehensive epilepsy centers in the United States and provides education to epilepsy programs, payers and the government. The codes are not consistent with how seizures are currently described in a patients chart. The best that a physician can do is provide a rough approximation of the diagnosis, as described in ICD-9, for the coder to assign.

Although the imprecise nature of the diagnosis codes is unfortunate, Gumnit points out that neither of these nonspecific codes has a negative impact on reimbursement levels. He adds that ICD-10, due to be published in 2003, is expected to improve the epilepsy codes to a degree, though not as completely as epileptologists would like.

Janell Behnke, medical business specialist for the Iowa Medical Society, agrees with Gumnit, but also notes that there are times when more precise epilepsy codes can be assigned. Sometimes, the neurologist is able to document identifiable forms of epileptic seizures as they are defined in ICD-9. For instance, seizures that [...]