Neurology & Pain Management Coding Alert

ICD-9 2010 brings several changes that will ease your reporting of frequently encountered dementia, Alzheimer's, and traumatic brain injury signs and symptoms.

Adding a fifth digit to signs and symptom codes can be beneficial to neurology coders as some extant codes don't fit exactly to what the patient's chief complaint is, says Sandra Harris, CPC, CPC-H, with Hampton Roads Neurology in Newport News, Va.

"We have many patients with dementia and Alzheimer's, and most of them come in because they are experiencing mood changes," Harris notes. As a result, you have to use another specified code. The patient may only be experiencing a behavior temporarily so diagnosis codes that can more precisely describe the patient's complaint are beneficial.

The new codes are an extension of ICD-9 2009's code for nervousness (799.2), says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting and Coding Education LLC. Besides adding a fifth digit to the 799.2 subcategory code, it is also getting a new description (Signs and symptoms involving emotional state) that more accurately classifies these diagnoses. The new codes are:

• 799.21 -- Nervousness

• 799.22 -- Irritability

• 799.23 -- Impulsiveness

• 799.24 -- Emotional lability

• 799.25 -- Demoralization and apathy

• 799.29 -- Other signs and symptoms involving emotional state.

The 2010 ICD-9's Alphabetic Index will help direct you to review the new diagnosis codes rather than ICD-9 codes in the Mental Disorders chapter (290-319). For example, the 2009 Alphabetic Index listing for "Labile, emotions" directed you to review 301.3 (Explosive personality disorder), whereas in 2010 neurology providers will report the new 799.24 ICD-9 code.

You can use these new fifth-digit ICD-9 codes to report emotional and/or behavioral symptoms, Harris says. If these symptoms are associated as a late effect to a traumatic brain injury (TBI), the new ICD-9 code(s) could be paired with the appropriate late effect code, such as 905.0 (Late effect of fracture of skull and face bones) or 907.0 (Late effect of intracranial injury without mention of skull fracture).

Coding of late effects generally requires sequencing the condition or nature of the late effect first and the late effect code second. Therefore, you would list 799.2x as the primary diagnosis followed by the appropriate late effect code as the secondary diagnosis.

Note: ICD-9-CM guidelines indicate that a late effect is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used.  The residual may be apparent early, such as cerebrovascular accident cases, or it may occur months or years later, such as that due to a previous injury.

Watch out: If the emotional or behavioral signs and symptoms are inherent or an integral part of an established diagnosis or syndrome, then you should not separately code them, according to the ICD-9-CM Coordination and Maintenance committee report.

Example: If the patient is already diagnosed with Alzheimer's (331.0), then it is not appropriate to also code for irritability, since it is generally a symptom associated with the disease. An exception would be when your neurologist documents that the sign or symptom is not related to the disease process.