Neurology & Pain Management Coding Alert

Question: I-m a new neurology coder trying to code for one of our patients who has diabetic neuropathy. My problem is that our neurologist has only indicated that the patient has diabetic neuropathy without being any more specific than that. Is there any way that I can code for this as it is, or do I need more information?

South Dakota Subscriber

Answer: You-ll definitely need to get more information than you have right now to make sure your payer reimburses you correctly.

Here's what to do: You always need to submit the appropriate ICD-9 diagnosis code with the claim to avoid being denied by your carrier and to keep from having a delay in processing. You need to code the diagnosis based on the highest level of specificity documented. Because you-re coding for diabetic neuropathy, a good place to start the search for the appropriate code is 250.6x (Diabetes with neurological manifestations).

As you can see, this code needs a fifth digit. Experts say that many charts don't include enough information to choose the correct fifth digit. This can create inaccurate claims or cause problems for you later on. Here's a useful list of fifth-digit subclassifications you can share with your neurologist and keep on hand when you-re coding for any diabetes patient:

- 0 -- type II or unspecified type, not stated as uncontrolled

- 1 -- type I (juvenile type), not stated as uncontrolled

- 2 -- type II or unspecified type, uncontrolled

- 3 -- type I (juvenile type), uncontrolled.

More complications: The neurologist should also document the disease manifestation so you can choose the proper secondary code.

In your case, in addition to the primary diabetic neuropathy code 250.6x, you should ask the neurologist whether you need to report 357.2 (Polyneuropathy in diabetes) or 337.1 (Peripheral autonomic neuropathy in disorders classified elsewhere).

Helpful hint: You can count on some extra help from ICD-9. It includes 357.2 in the alphabetic index with diabetic neuropathy. The italicized notes for this code will lead to the secondary code (250.6x), which means you need to get an additional diagnosis from the neurologist for the claim.