Neurology & Pain Management Coding Alert

Ataxia, Dravet syndrome also get Dx additions.

ICD-10 released its new set of codes for 2021 recently, and coders need to start familiarizing themselves with the codes now, not later.

Why? As always, the ICD-10 2021 codes are official on October 1, 2020. So you’ve got about two months to get used to all of the additions, deletions and revisions that ICD-10 2021 will bring.

Check out the most impactful changes to ICD-10 for your practice

COVID-19 Keeps U07.1

The most important addition to the 2021 ICD-10 code book is also the least surprising; in October, U07.1 (COVID-19) will be recorded in the ICD-10 manual.

This is just a formality, however, as the code has been official since April. Experts were amazed at the quickness with which U07.1 was added to the ICD-10 rolls — but it made sense considering the unprecedented public health emergency (PHE) and the lack of an accurate diagnosis code for the situation.

“The speed that the ICD-10-CM Coordination and Maintenance Committee approved this new code is unprecedented,” said Betty Ann Price, BSN, RN, president and founder of Professional Reimbursement and Coding Strategies, and AHIMA-approved ICD-10-CM trainer. “The new code, U07.1, was initially assigned by the World Health Organization. Usually it requires at least a one-year process to get a new code adopted, but this went through with exceptional speed.”

The early adoption of U07.1 was necessary, however, to “fulfill the imperative need to track the diagnosis of this condition as well as its subsequent treatment,” explains Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

In the notes beneath U07.1, coders are instructed to use an additional code to “identify pneumonia or other manifestations.” There are also several Excludes1 diagnoses as well, such as:

• B34.2 (Coronavirus infection, unspecified)
• B97.2- (Coronavirus as the cause of diseases classified elsewhere)
• J12.81 (Pneumonia due to SARS-associated coronavirus)

Headache NOS Gets Extra Character

There were also a couple of changes to how you’ll code for certain headaches on October 1. ICD-10 added R51.0 (Headache with orthostatic component, not elsewhere classified). You should also use this code to identify headache with positional component, not elsewhere classified.

Also, ICD-10 moved unspecified headaches to its own classification, R51.9 (Headache, unspecified).

In 2020, this code set consisted only of R51 (Headache). In 2021, you’ll use R51.9 to report headache NOS.

Ataxia, Dravet Syndrome Get New Codes

There will be a few changes to the “G11 Hereditary ataxia” category as well. On October 1, ICD-10 will add these codes to the set:

• G11.10 (Early-onset cerebellar ataxia, unspecified)
• G11.11 (Friedreich ataxia)
• G11.19 (Other early-onset cerebellar ataxia)

Definition: According to ataxia.org, “ataxia is a degenerative disease of the nervous system. Many symptoms of ataxia mimic those of being drunk, such as slurred speech, stumbling, falling, and incoordination. These symptoms are caused by damage to the cerebellum, the part of the brain that is responsible for coordinating movement.”

Coders should take a look at G20 (Parkinson’s disease) entry in ICD-10 2021; there will be instructions to use an additional code to identify dementia with behavioral disturbance (F02.81) or dementia without behavioral disturbance (F02.80).

Finally, ICD-10 2021 will also add several codes to G40.- (Epilepsy and recurrent seizures) to represent some specific conditions. The latest diagnosis code book will feature the following new codes:

• G40.42 (Cyclin-Dependent Kinase-Like 5 Deficiency Disorder)
• G40.83 (Dravet syndrome)
• G40.833 (Dravet syndrome, intractable, with status epilepticus)
• G40.834 (Dravet syndrome, intractable, without status epilepticus)

Definition 1: “Cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD) is a developmental encephalopathy caused by pathogenic variants in the gene CDKL5. This unique disorder includes early infantile onset refractory epilepsy, hypotonia, developmental intellectual and motor disabilities, and cortical visual impairment,” according to the National Institutes of Health (NIH).

Definition 2: Dravet syndrome “is a rare, catastrophic, lifelong form of epilepsy that begins in the first year of life with frequent and/or prolonged seizures,” according to. Dravet syndrome was previously known as severe myoclonic epilepsy of infancy (SMEI).