Neurology & Pain Management Coding Alert

Code neurological issues to avoid duplicating primary physicians diagnoses.

Your neurologist doesnt treat septicemia and urinary tract infections as primary conditions, but these conditions still affect your neurology coding.

Study how these conditions relate to neurological conditions to get the right consult/diagnoses combo on your next nonstandard claim.

Look for a Neuro-Septicemia Connection

Urinary and sepsis issues may appear unrelated to the neurological conditions your practice is used to coding. However, a UTI can in fact lead to neurological problems in elderly patients.

A UTI means there are microorganisms, such as bacteria or fungus, in the patients urine, says Eugene C. Lai, MD, PhD, professor in the department of neurology at Baylor College of Medicine in Houston.

When cultures grow out infectious agents which have spread through the body via the bloodstream, a physician might diagnose septicemia (038.9, Unspecified septicemia), bacteremia (790.7), or urosepsis (599.0, Urinary tract infection, site not specified; or 995.91, Sepsis). These are more serious medical conditions that require intravenous (IV) antibiotic and hospitalization for patients of any age, Lai says.

The infection will frequently cause encephalopathy with altered mental status and will aggravate any neurological condition the patient already has, Lai adds. This can cause weakness, confusion, agitation, somnolence, and other problems.

Think Consult for Uro-Related Cases

Your neurologist generally wont be treating patients for sepsis and/or UTI. Your physician will typically see these patients when doing a consult for another physician.

We see it more often in hospital consultations when the patient is being treated for another condition but is experiencing symptoms such as delirium or altered mental status, Lai says. Your neurologist may need to rule out seizure or other neurologicalrelated conditions for a particular patient.

When your neurologist sees the patient during an inpatient consult, report the encounter with the appropriate code from 99251-99255 (Inpatient consultation for a new or established patient ...).

If the patient is agitated or confused, we might prescribe medications to help, Lai says. Otherwise we dont normally order medications for the patient but advise the other physician regarding appropriate treatment.

Additionally, any new illness can make a patients chronic neurological illness worse, adds Neil Busis, MD, of the University of Pittsburgh Medical Center at Shadyside. The primary-care physician or hospitalist will address the medical issues, and we will address the neurological ones, he says.

Be Ready to Report Multiple Diagnoses

UTI or septicemia wont be a primary diagnosis for your neurologist. ICD-9 guidelines are written in general terms for an admitting/attending physician, such as a primary-care, internal medicine, or hospitalist physician.

Example: A patient with a history of traumatic brain injury presents with altered mental status and infection at the site of a ventriculoperitoneal (VP) shunt with suspected cellulitis.

The primary diagnosis is 780.97 (Altered mental status). You report 996.63 (Infection and inflammatory reaction due to internal prosthetic device, implant, and graft; due to nervous system device, implant, and graft) as a secondary diagnosis since your neurologist is not treating the patient for the infection; this code represents the problem with the VP shunt.

Youll also list V15.59 (Other personal history presenting hazards to health; other injury) as a tertiary diagnosis representing the history of traumatic brain injury.

In this case, note that the medical record does not mention sepsis. According to ICD-9 guidelines, Either the term sepsis or SIRS must be documented to assign a code from subcategory 995.9. In this example, the physicians documentation does not include the term sepsis so you should not report it.

Encephalopathy note: Many charts include documentation of encephalopathy. Since ICD-9 includes a range of diagnosis codes for encephalopathy, verify the patients condition with your neurologist before proceeding. Your most frequent choice will probably be 348.31 (Metabolic encephalopathy), which can include electrolyte abnormalities, infections, medication interactions, and more.

Double-Check Definitions Before Filing

Physicians and coders alike often use the terms  urinary tract infection, sepsis, and septicemia interchangeably, but these terms are not precise synonyms.

Learn these definitions from the HIPAA-mandated ICD-9-CM Guidelines and Stedmans Medical Dictionary to ensure you understand the terms before you code:

" Septicemia: Systemic disease associated with the presence of pathological microorganisms or toxins in the blood, which can include bacteria, viruses, fungi, or other organisms

" Systemic inflammatory response syndrome (SIRS): The systemic response to infection, trauma/burns, or other insult (such as cancer) with symptoms including fever, tachycardia, tachypnea, and leukocytosis

" Sepsis: Generally refers to SIRS due to infection

" Urinary tract infection: Microbial infection, usually bacterial, of any part of the urinary tract.

A diagnosis of UTI means the patient has bacteria growing in the urine. Septicemia, on the other hand, is more systemic; infection is present in the patients blood, which is a more serious condition.