Neurology & Pain Management Coding Alert

Our experts walk you through the new ICD-9 codes that will affect you most

CPT 2007 doesn't hold many earth-shattering changes for neurology coders, but ICD-9 has several new diagnoses you-ll use for restless legs syndrome, encephalitis, epilepsy and more. Be sure you update your system and use the new diagnoses instead of the less accurate stand-bys of the past.

Look for Fifth Digits for Encephalitis and Myelitis

ICD-9 2007 changes the encephalitis code family (323.x, Encephalitis, myelitis and encephalomyelitis) with revised descriptors and new fifth-digit codes throughout the section. Coders such as Sue Sluder, CPC, CPC-P, professional fee coder and physician billing specialist with the department of neurology at Baylor College of Medicine in Houston, are glad to see the additions because they frequently rely on encephalitis diagnoses.

The new fifth-digit clarifications include:

- 323.01 -- Encephalitis and encephalomyelitis in viral diseases classified elsewhere

- 323.02 -- Myelitis in viral disease classified elsewhere

- 323.41 -- Other encephalitis and encephalomyelitis due to infection classified elsewhere

- 323.42 -- Other myelitis due to infection classified elsewhere

- 323.51 -- Encephalitis and encephalomyelitis following immunization procedures

- 323.52 -- Myelitis following immunization procedures

- 323.61 -- Infectious acute disseminated encephalomyelitis (ADEM)

- 323.62 -- Other postinfectious encephalitis and encephalomyelitis

- 323.63 -- Postinfectious myelitis.

Remember -Recurrent Seizures- Go With Epilepsy

ICD-9 2007 revamps the epilepsy diagnoses by expanding several fourth-digit code titles to include partial seizures. Instead of relying on previous descriptors such as -epilepsy,- you now have more specific diagnoses to work with:

The broad codes of the past confused physicians and coders when they tried to pinpoint diagnoses related to epilepsy, and the updated, more complete descriptors aim to correct that problem.

-Our epilepsy specialists code their diagnoses specifically for this reason,- Sluder says. -We need to educate them on the new epilepsy codes.-

Uncertain conclusions: If your physician has not yet determined the patient's type of seizure or convulsive disorder, consider that Sluder's physicians use either 345.1x (Generalized compulsive epilepsy) or 780.39 (Other convulsions). 

Brush Up on New Pain-Related Options

Neurology coders often see pain-related diagnoses such as low back pain (724.2, Lumbago), neuropathic pain (729.9, Other and unspecified disorders of soft tissue), neck pain (723.1, Cervicalgia) and pain in limb (729.5).
 
Now you have more pain-related options, including:

- 338.0 -- Central pain syndrome

- 338.18 -- Other acute postoperative pain

- 338.19 -- Other acute pain

- 338.21 -- Chronic pain due to trauma

- 338.28 -- Other chronic postoperative pain

- 338.29 -- Other chronic pain 

- 338.3 -- Neoplasm-related pain (acute) (chronic)

Note: Terms in parenthesis designate nonessential modifiers, meaning the physician can include the terms in his diagnosis or can leave them out.

- 338.4 -- Chronic pain syndrome.

New code examples: You shouldn't have trouble figuring out when to report some of these new codes, such as acute postoperative pain. But here are examples for when you might use some of the more general codes:

- Other acute pain (338.19) could be when a patient complains of pain without an indication of its cause (such as back pain without an injury or definitive diagnosis).

- Chronic pain from trauma (338.21) could be when a patient has continued pain after an auto accident.

- Chronic pain syndrome (338.4) could be for an unspecified pain syndrome such as a patient who sprained her back a year ago but still has pain.

Catch Single Changes Before They Slip Past

Because many code updates apply to entire sections of ICD-9, single code changes might slip past unnoticed. Two stand-alone revisions you-ll need to know about apply to restless leg syndrome and altered mental status:

- Look to new code 333.94 (Restless legs syndrome) instead of reporting your former option of 333.99 (Other and unspecified extrapyramidal diseases and abnormal movement disorders; other).

- Altered mental status is the reason for many neurological consults, Sluder says. ICD-9 2007 changes the code from 780.02 (Transient alteration of awareness) to 780.97 (Altered mental status).