Neurology & Pain Management Coding Alert

Question: Our neurologists saw a case of temporal sclerosis. What code should I use for this?

New York Subscriber

Answer: Starting Oct. 1, you'll have a specific code for the disease. ICD-9 2010 will include 348.81 (Temporal sclerosis).

What is it? Although temporal sclerosis is uncommon among the general population, it is the most common form of lesion associated with temporal epilepsy. Neurologists often suspect temporal sclerosis when patients have epileptic symptoms such as muscle spasms, convulsions, and seizures.

Temporal sclerosis may cause epilepsy. This disease is characterized by the loss of neurons (nerve cells) and scarring of the temporal lobe associated with certain brain injuries, for example traumatic injury, infection, brain tumor, lack of oxygen, or uncontrolled seizure. Damage to this part of the brain can cause a partial (focal) form of epilepsy known as temporal lobe epilepsy. This is listed as a separate code in ICD-9: 345.5 (Localization-related [focal] [partial] epilepsy and epileptic syndromes with simple partial seizures).

Code 348.81 includes more specific conditions. The majority of temporal lobe epilepsy cases are associated with mesial temporary sclerosis, which is a more specific form of temporal sclerosis. Mesial temporal sclerosis is also known as hippocampal sclerosis. In a vicious cycle of events scenario, additional seizures can worsen mesial temporal sclerosis. Both conditions are listed under code 348.81.