Neurology & Pain Management Coding Alert

Location matters when choosing an I60.XX code.

One important change that ICD-10 has introduced is that it clearly specifies that the codes I60.XX are for subarachnoid hemorrhage of a nontraumatic in nature. Once you have confirmed that the bleed was not preceded by trauma, you can easily hit the right code if you look for site of hemorrhage and side of hemorrhage.

Step 1: Determine the Site of the Bleed

Your first guide to the right code for subarachnoid hemorrhage which is not a consequence of trauma is to determine the site the bleed in the cerebral circulation. Your first step is to determine if the site of the bleed was the vertebral artery, basilar artery, anterior or posterior communicating artery, middle cerebral artery, carotid artery, or other intracranial arteries.

"This is much more specific than previously reported under ICD-9," says Gregory Przybylski, MD,  director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. "Sometimes, the actual source may not be determinable when more than one aneurysm is present in close proximity to one another but on different vessels. Unspecified diagnostic codes allow for reporting such conditions."

Step 2: Confirm If the Bleed Was Left- or Right-Sided

The next important step is to check in the clinical note if the hemorrhage was on the right or the left side of the head.

"You should report the most specific ICD-10 diagnostic code that you can based on the information available to you," Przybylski says. "Remember that for this first year of ICD-10 implementation, CMS is only requiring ICD-10 family accuracy (first three alphanumeric characters before the decimal)."

Note: If, however, your provider does not mention the side of the hemorrhage, you may report the unspecified codes for different sites.

Take this quick quiz to strengthen your understanding of nontraumatic subarachnoid hemorrhage coding. To check the answers, turn to page 77.

Question 1: Which of the following ICD-10 codes do you submit for nontraumatic subarachnoid hemorrhage from carotid bifurcation?

a) I60.00
b) I60.01
c) I60.02
d) I60.10

Question 2: Which of the following ICD-10 codes do you submit for nontraumatic subarachnoid hemorrhage from basilar artery?

a) I60.1
b) I60.4
c) I60.5
d) I60.3

Question 3: Which of the following ICD-10 codes do you submit for nontraumatic subarachnoid hemorrhage from right middle cerebral artery?

a) I60.10
b) I60.11
c) I60.50
d) I60.51

Question 4: Which of the following ICD-10 codes do you submit when your provider does not document the location of the bleed?

a) I60.4
b) I60.50
c) I60.6
d) I60.7