Neurology & Pain Management Coding Alert

Remember to report associated symptoms until final diagnosis is reached. 

Approximately 10,000 new cases of multiple sclerosis are diagnosed each year, which means it’s not uncommon for your neurologist to treat these patients. Here’s your chance to refresh your memory on what multiple sclerosis (MS) is, how it affects patients, and how you should determine the correct diagnoses.

Start by Understanding the Condition 

Multiple sclerosis is a disease that affects the brain and spinal cord, which leads to a loss of muscle control, vision, balance, and sensation (such as numbness). MS gets its name from the buildup of scar tissue (sclerosis) in the brain and/or spinal cord. The scar tissue forms when myelin (the protective tissue covering nerves) is destroyed. This process is known as demyelination. 

When nerves aren’t covered by myelin, signals transmitted throughout the brain and spinal cord are disrupted or stopped. The brain is no longer able to send and receive messages. 

Nerves can regain myelin, but the process isn’t fast enough to counter the deterioration that occurs in MS. The types and severity of symptoms and the course MS takes in a patient can vary widely, partly because of the location of scar tissue and the extent of demyelination. 

Code Symptoms Leading to Diagnosis 

A diagnosis of MS requires evidence of at least two areas of damage in the central nervous system that have occurred at different times. Until your physician is able to confirm a diagnosis, you’ll code the patient’s care based on the symptoms exhibited. 

The National Multiple Sclerosis Society’s website lists a wide range of possible symptoms. Some of the more common include: 

• Fatigue that significantly interferes with daily life activities (780.79, Other malaise and fatigue)
• Walking (gait) difficulties (781.2, Abnormality of gait)
• Numbness or tingling in the face, body, or extremities (782.0, Disturbance of skin sensation)
• Muscle weakness (728.87, Muscle weakness [generalized]) 
• Spasticity (781.0, Abnormal involuntary movements)
• Bladder dysfunction (596.59, Other functional disorder of bladder)
• Pain syndromes (such as 338.0, Central pain syndrome, 338.29, Other chronic pain, or 338.4, Chronic pain syndrome). 

Less common symptoms of MS can be: 

• Difficulty swallowing (787.20, Dysphagia, unspecified)
• Speech problems, including slurring (784.51, Dysarthria) and loss of volume (784.42, Dysphonia) 
• Tremors (such as 781.0 or 728.85, Spasm of muscle)  
• Seizures (780.39, Other convulsions). 

When the neurologist has enough information to confirm a diagnosis of MS, you’ll report 340 (Multiple sclerosis), which includes disseminated or multiple sclerosis. The physician might document multiple sclerosis NOS, generalized, or related to the brain stem or spinal cord.

Tie In Associated Conditions 

Because multiple sclerosis affects the nervous system, patients often need treatment for problems associated with MS. When that’s the case, list the current condition in addition to the MS diagnosis. 

Example: A patient is experiencing acute exacerbation of her MS, including increased gait problems and difficulty performing activities of daily living. She was previously diagnosed with neurogenic bladder. Your provider will be seeing her to draw blood to assess the new medication she started a few weeks ago. He also will complete a neurological assessment and change her Foley catheter. 

Code it: You’ll submit several codes for this visit: 

• 340 (Multiple sclerosis) 
• 596.54 (Neurogenic bladder NOS) 
• V58.83 (Encounter for therapeutic drug monitoring) 
• V58.69 (Long-term [current] use of other medications) 
• V53.6 (Fitting and adjustment of urinary devices). 

Note: Although your patient is experiencing gait problems, you shouldn’t include 781.2 (Abnormality of gait) because this is an integral symptom of her MS.

Look ahead to ICD-10: When ICD-10 becomes effective in October 2015, you’ll find that multiple sclerosis has a direct matching code: G35 (Multiple sclerosis). The new code will still apply to multiple sclerosis of brain stem, spinal cord, generalized multiple sclerosis, and the non-specified conditions as well. Also note that G35 is an example of how ICD-10 will include some three-digit codes just at ICD-9 does. The majority of ICD-10 codes will have more characters, but don’t be surprised when you find a valid three-digit choice.