Neurology & Pain Management Coding Alert

Follow these 3 steps to start a successful claim

Almost half of diabetes patients have diabetic neuropathy (a nerve disorder caused by the disease), which means they can come to your neurologist for care. Keep these three steps in mind when you-re faced with coding their care.

1. Determine Whether It's a Consult or Referral

Patients with diabetic neuropathy lose sensation in their feet (and possibly hands) and have foot pain and weakness. The condition can move slowly, taking years to lead to conditions such as foot muscle weakness. Occasionally, the condition flares and affects a specific nerve, causing additional weakness or pain.

An endocrinologist will manage the patient's care as long as he feels comfortable doing so. But the condition often reaches the point where the endocrinologist might refer the patient to a neurologist or pain management specialist for advice or specific care.

Visit check: If the patient's initial visit to your physician qualifies for an office visit code, start by determining whether it qualifies as a consult or referral. A consult happens when the neurologist sees the patient and recommends something related to treatment. A referral, on the other hand, happens when another physician (an endocrinologist, in this case) sends the patient to your neurologist for treatment.

Consult coding: Report a new or established patient office consultation with the appropriate choice from 99241-99245 (Office consultation for a new or established patient ...). If your neurologist performs the consult in the hospital, choose from 99251-99255 (Inpatient consultation for a new or established patient ...) instead.

Referral choices: If the patient encounter is a referral instead of a consult -- meaning that your neurologist will take over the patient's care -- choose your code from 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...).

2. Verify the Type of Pain

When you-re coding for diabetic neuropathy treatment, you should understand the type of pain the patient is experiencing. Neuropathic pain can have up to three different components, says Barbara Johnson, MPC, CPC, owner of Real Code Inc. in Moreno Valley, Calif.:

- Ongoing pain that is continually present regardless of what the patient does or does not do

- Spontaneous pain episodes that suddenly appear without any identifiable stimulus

- Hyperalgesia, in which the patient has pain from an external stimulus that normally causes little or no pain (such as heat or cold).

In addition to being categorized by the type of pain experienced, the affected body area also helps classify diabetic neuropathy. These include:

- Peripheral neuropathy, which causes pain or loss of feeling in the toes, feet, legs, hands and arms. This type of neuropathy is extremely common, according to Johnson.

- Autonomic neuropathy, which causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure.

- Proximal neuropathy, which causes pain in the thighs, hips or buttocks and leads to weakness in the legs. Some people call this polyneuropathy because it involves two or more extremities.

- Focal neuropathy, which leads to sudden weakness of one nerve or group of nerves and causes muscle weakness or pain. This type of neuropathy can affect any nerve in the body.

3. Narrow Your Diagnosis Choices

Patients often have multiple diagnoses and treatments related to their diabetes that your neurologist must consider during treatment -- and that you must consider when coding.

-Physicians often indicate that the patient has diabetic neuropathy without being more specific,- says Susan West, CPC, a coder and auditor with Auditing for Compliance and Education in Leawood, Kan. But you need more than that to make sure claims get filed and reimbursed correctly.
 
-You must submit an appropriate ICD-9 diagnosis code with each claim,- West says. -Otherwise, the carrier might deny the claim or delay processing. One of our biggest challenges is educating the physicians about the need to clarify the patient's specific diagnosis so we can assign a proper ICD-9 code.-

As with any condition, code the diagnosis based on the highest level of specificity documented. The code for diabetic neuropathy (250.6x, Diabetes with neurological manifestations) needs a fifth digit, but West says many charts don't include the correct fifth digit -- which can lead to inaccurate charts or problems down the road.

Remember these fifth-digit subclassifications when coding for any diabetes patient:

- 0 -quot; Type II or unspecified type, not stated as uncontrolled

- 1 -quot; Type I (juvenile type), not stated as uncontrolled

- 2 -quot; Type II or unspecified type, uncontrolled

- 3 -quot; Type I (juvenile type), uncontrolled.

To further complicate matters, West says physicians often fail to include a secondary code for the disease manifestation on the encounter form.

Check with your neurologist to determine whether you should report 357.2 (Polyneuropathy in diabetes) or 337.1 (Peripheral autonomic neuropathy in disorders classified elsewhere) in addition to the primary diabetic neuropathy code 250.6x.

Tip: ICD-9 helps guide you to the secondary code by including 357.2 in the alphabetic index with diabetic neuropathy. That's your hint that you should always get an additional diagnosis from your neurologist for the claim.

Heads up: Following these three steps helps you head in the right direction for diabetic neuropathy coding, but don't complete your claim. Watch for tips next month on correctly coding the blocks your physician might use to treat diabetic neuropathy.