Neurology & Pain Management Coding Alert

Question: Our neurologist performed a consult associated with diagnosing metastatic brain cancer, seizure and progressive cognitive decline due to chemotherapy and radiation therapy. How should I code this case?

Montana Subscriber

Answer: Report the main reason the patient came to your neurologist as the primary diagnosis, followed by codes for current conditions and the patient's history of chemotherapy and radiation therapy.
 
ICD-9 choices in this case could include 780.93 (Memory loss), the appropriate code for cancer of the brain depending on the cancer status (such as 198.3, Secondary malignant neoplasm of other specified sites; brain and spinal cord), or 780.39 (Other convulsions).

You could also report 780.39 for the seizure and 294.9 (Unspecified persistent mental disorders due to conditions classified elsewhere) for the cognitive decline. Include V15.3 (Irradiation) for the patient's radiation therapy history.

For your neurologist's consult, follow his documentation to select the best choice from 99241-99245 (Office consultation for a new or established patient ...).