Neurology & Pain Management Coding Alert

Descriptor will no longer specify presence of neurogenic bladder.

You might not see a diagnosis of cauda equina syndrome very often because it’s a relatively rare condition. When your physician does treat these patients, you currently report diagnosis 344.60 (Cauda equina syndrome without neurogenic bladder) or 344.61 (Cauda equina syndrome with neurogenic bladder) from ICD-9. Coding notes state that 344.60 and 344.61 include complete or incomplete paralysis, except for conditions that fall under code families 342 (Hemiplegia and hemiparesis) or 343 (Infantile cerebral palsy).

ICD-10 includes one code specific to cauda equina syndrome: G83.4. The descriptor does not mention neurogenic bladder as the ICD-9 code does, but according to coding notes, G83.4 does include “neurogenic bladder due to cauda equina syndrome.” The Excludes1 notes direct you to other codes for cord bladder NOS (G95.89) and neurogenic bladder NOS (N31.9).

When conditions of the nervous system affect the bladder, it is called “neurogenic bladder.” Stroke, Parkinson’s disease, multiple sclerosis, disk herniation, and other nervous system abnormalities can result in neurogenic bladder.

Two major types of bladder control problems are associated with a neurogenic bladder. Depending on the nerves involved and nature of the damage, the bladder becomes either overactive (spastic or hyper-reflexive) or underactive (flaccid or hypotonic).

Coding notes: Because of the way the ICD-9 codes are structured, your providers should already be accustomed to documenting whether the patient has neurogenic bladder. That distinction isn’t emphasized as much with ICD-10, but the notation will strengthen your provider’s documentation.

What it is: Cauda equina syndrome is a serious condition that describes extreme pressure and swelling of the nerves at the end of the spinal cord. It gets its name from Latin term “horse’s tail” because the nerves at the end of the spine visually resemble a horse’s tail as they extend from the spinal cord down the back of each leg.

Cauda equina syndrome is a serious medical emergency that requires testing and possibly urgent surgical intervention. If patients with cauda equina syndrome do not get treatment quickly, adverse results can include permanent paralysis, impaired bladder and/or bowel control, difficulty walking, and/or other neurological and physical problems.