Neurology & Pain Management Coding Alert

Question: Which ICD-9 code should I use for progressive generalized weakness only?

Alaska Subscriber

Answer: For generalized weakness only, you should assign ICD-9 780.79 (Other malaise and fatigue). Code 780.79 is for a "nonspecific" diagnosis, and you should report it only if the physician can identify no other, more specific symptoms. Payers prefer definitive diagnoses and may choose to reject your claim for lack of medical necessity, especially if you link the diagnosis to a higher-level E/M service or other costly procedure.
 
Before reporting 780.79, or any other "unspecified" diagnosis, check with the rendering neurologist to be sure that he cannot provide a more precise diagnosis. The extra effort could mean the difference between payment and a rejected claim.