Neurology & Pain Management Coding Alert

Prepare for extra digits explaining more details.

Currently, ICD-9-CM makes coding for late effects of cerebrovascular disease fairly simple. You go to code family 438.xx (Late effects of cerebrovascular disease) and choose the code best describing the condition causing the late effects. Options include cognitive or speech/language deficits, hemiplegia, vision disturbances, and others.

What's missing: ICD-9-CM codes do not specify the underlying etiology or laterality. ICD-10 will change that in October 2013, with new terminology, etiology details, and anatomic references.

Changes: Diagnoses related to late effect of cerebrovascular disease will be in code block I69.xx (Sequelae of cerebrovascular disease) under ICD-10. The term "sequelae" has historically been used in ICD-10. Sometimes a patient's current condition is caused by an original condition or injury that is no longer present. One is said to be the sequela (late effect) of the other. You'll have more than 150 code choices distinguished by underlying etiology (such as nontraumatic subarachnoid hemorrhage, nontraumatic intracerebral hemorrhage, cerebral infarction, unspecified cerebrovascular diseases, and more). Sixthdigit choices will indicate dominant and non-dominant, as well as right and left sides when applicable.

Example: Diagnosis I69.341 describes monoplegia of the patient's lower limb following cerebral infarction affecting the right dominant side. In the same code block, diagnosis I69.343 describes monoplegia of the lower limb following cerebral infarction affecting the right nondominant side.

Prepare: Start educating your physicians now about how much more detailed their documentation, including the affected side and whether it is the patient's dominant or non-dominant side, will need to be for ICD-10. Begin implementing some trial audits based on ICD-10 coding guidelines to help gauge how well you're currently doing and next steps you might need to take.