Neurology & Pain Management Coding Alert

'Specificity' is the watchword for ICD-9 coding

The best way to fight denials based on incomplete diagnosis codes is to be sure that you always report your diagnoses to the highest level of specificity that the neurologist's documentation will support.
 
Many carriers are rejecting claims as "medically unnecessary" at a higher rate than they were just a few years ago, which makes proper diagnosis coding more important than ever before.

Times Have Changed

"A lot of us didn't pay attention to ICD-9 coding in the past because Medicare was the only carrier that cared if you used the correct codes," says Victoria Jackson, owner of Omni Management, which provides practice management services for 15 medical offices in the Los Angeles area. Now, all insurance companies are looking for ICD-9 codes, and coders must be more vigilant about the diagnoses they assign.

Watch for 'Checks' in ICD-9

You should always report the ICD-9 code that provides the highest degree of accuracy for the condition the neurologist is treating.
 
"That 'highest degree' means that you should assign the most precise ICD-9 code that most fully explains the narrative description of the symptom or diagnosis," says JoAnn Baker, CCS, CPC-H, CPC, CHCC, an education specialist in East Orange, N.J.
 
Strategy for success: To ensure you use the most accurate ICD-9 code every time, Margaret Lamb, RHIT, CPC, coding expert in Great Falls, Mont., suggests asking two questions before sending out a claim:

 1. Do I have a complete code?
 2. Do I have the most specific complete code?

Rely on your ICD-9 manual's instructions to ensure you're listing complete ICD-9 codes. If you see a check mark with a "4th" or "5th" next to a code, ICD-9 is telling you that the code requires a fourth or fifth digit. Anything less would result in an incomplete claim.
 
For example: If you find the tabular listing for diabetes (250.xx), you'll see a box with a check mark and "5th" printed next to it to the left of the code. This box indicates that a complete ICD-9 code for a diabetes diagnosis must be five digits.
 
Why? You need five digits to reflect both the complications from diabetes, such as neurological manifestations (for instance, tingling, numbness, and lack or loss of sensation), as well as insulin dependence (or the lack thereof).
 
The code for non-insulin-dependent diabetes with neurological complications is 250.61 (Diabetes with neurological manifestations; type I [juvenile type], not stated as uncontrolled).
 
Such careful coding is especially necessary for the neurologist treating a diabetic patient, because the neurologist is likely treating the complications of the diabetes rather than the diabetes itself. Without the proper ICD-9 to indicate neurological manifestations, the insurer would likely rule a neurologist's care unnecessary.
 
Key idea: If the ICD-9 code is not as specific as carrier rules require, the claim may be rejected for lack of medical necessity and/or a truncated code, Lamb says.

Don't Stop Short When Selecting Symptoms

When working with diagnosis coding, you must remain up-to-date with your codes and read though a code listing entirely, or you may find yourself forgetting a fourth or fifth digit.
 
This past October, ICD-9 added a plethora of new codes, many of which were the result of expanding four digits to five digits, allowing the specification of conditions that previously went unspecified.
 
For example: For 2005, ICD-9 added four new narcolepsy codes: