Neurology & Pain Management Coding Alert

The next time you face a joint injection or nerve destruction report for a diabetic neuropathy patient, you can breathe easy. Our experts reveal three can-t-miss tips that make sure you choose the right ICD-9 codes every time.

Ground rule: Accurately using 337.1 (Peripheral autonomic neuropathy in disorders classified elsewhere) or 357.2 (Polyneuropathy in diabetes) depends on meeting ICD-9 requirements to code to the highest specificity possible, says Robert Jackson, MD, of Dickson Medical Associates, a multispecialty practice in Tennessee. With these steps, you can be sure you-re putting the right code in the right spot on your claims.

When your neurologist treats a patient for neuropathy, you should report the primary or underlying disease causing the neuropathy or polyneuropathy first on the claim, says Susan West, RHIT, compliance auditor at Auditing for Compliance and Education (ACE) Inc. in Leawood, Kan.

You should list the neurological manifestation (337.1 or 357.2) as a secondary diagnosis.

Do this: When coding for diabetic neuropathy, assign 250.6x (Diabetes with neurological manifestations) with the appropriate fifth digit, such as 0 (type II or unspecified type, not stated as uncontrolled), as the primary diagnosis.

Note: Diabetes often causes neuropathy, a general term for damage or destruction of the peripheral nerves.

Crucial: Adhere to these coding combinations:

- Polyneuropathy (357.2) can only be paired with diabetes (250.6x).

- But you can list neuropathy (337.1) with a primary diagnosis of diabetes (250.6x) or amyloidosis (277.30-277.39).

Before sealing your neuropathy diagnosis, memorize this phrase: Equate polyneuropathy with peripheral mononeuropathy. AHA's ICD-9 Coding Clinic lists 250.6x and 357.2 as the codes for peripheral (or cranial) neuropathy (see "Fourth Digit 6: 250.6x" in the 1991 third-quarter issue).

You can focus on patient symptoms and E/M service details for clues to help you identify peripheral neuropathy (polyneuropathy) versus autonomic neuropathy.

"Manifestations for peripheral and autonomic neuropathy are different," says Bruce Rappoport, MD, CPC, CHCC, medical director of Broward Health's Best Choice Plus and Total Claims Administration in Fort Lauderdale, Fla.

Be on the lookout for these history and physical exam findings:

Symptoms: Peripheral neuropathy describes when a patient has pain and numbness in her hands and feet, typically describing it as "tingling or burning" and often comparing the loss of sensation "to the feeling of wearing a thin stocking or glove," according to the Mayo Clinic (www.mayoclinic.com/health/peripheral neuropathy/DS00131).

Causes: Patients may develop peripheral neuropathy due to traumatic injuries, infections, metabolic problems and toxin exposure.

One common cause of the disorder is diabetes. Peripheral neuropathy symptoms often improve with time -- especially if they-re caused by an underlying condition that can be resolved.

Action: "If the physician's notes indicate a peripheral polyneuropathy (with no additional specificity), the coder must look to the 357.x (Inflammatory and toxic neuropathy -) code range depending on the underlying disease," says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, principal of MJH Consulting in Denver. You would use "2" as the fourth digit for diabetes.

What it is: A patient with autonomic neuropathy has damage to nerves regulating involuntary body functions. Autonomic neuropathy results in faulty communication between the brain and parts of the body that the autonomic nervous system serves.

To treat autonomic neuropathy, the physician addresses the underlying cause, if possible, and manages the signs and symptoms.

Do this: "If the provider documents that the peripheral neuropathy involves the autonomic nervous system, the coder should look to 337.1," Hammer says.