Neurology & Pain Management Coding Alert

Prepare for multiple choices regarding secondary Parkinsonism.

When ICD-10 goes into effect in October 2013, you'll have more coding options for Parkinson's disease -- which means neurologists will need to specify more details in their documentation when they diagnose patients.

Currently, ICD-9-CM has two diagnoses for Parkinson's disease, and each qualifies the types of conditions included:

• 332.0 (Paralysis agitans) encompasses idiopathic or primary forms of Parkinsonism or Parkinson's disease, or Parkinson's NOS.
• 332.1 (Secondary Parkinsonism) includes neuroleptic-induced Parkinsonism or Parkinsonism due to drugs.

ICD-10 changes: Diagnosis 332.0 will change to G20 (Parkinson's disease) under ICD-10. Coding guidelines state that you shouldn't report G20 for dementia and Parkinsonism; instead, submit G31.83 under ICD-10.

Diagnosis 332.1, however, will expand to numerous specific codes instead of a single catch-all code for secondary Parkinsonism. Each code for secondary Parkinsonism excludes dementia with Parkinsonism (G31.83), Huntington's disease (G10), Shy-Drager syndrome (G90.3), and syphilitic Parkinsonism (A52.19).

Your new options for 332.1 will include:

• G21.0 -- Malignant neuroleptic syndrome
• G21.11 -- Neuroleptic induced Parkinsonism
• G21.19 -- Other drug induced secondary Parkinsonism
• G21.2 -- Secondary Parkinsonism due to other external agents
• G21.3 -- Postencephalitic Parkinsonism
• G21.4 -- Vascular Parkinsonism
• G21.8 -- Other secondary Parkinsonism
• G21.9 -- Secondary Parkinsonism, unspecified.

Several of the new Parkinson's diagnoses direct you to first code the drug or external agent causing secondary Parkinsonism. Start encouraging your providers to be more specific with their documentation now, for an easier ICD-10 transition later.