Neurology & Pain Management Coding Alert

Question: Our neurologist sometimes completes a punch biopsy to look for small fiber neuropathy. The payer denied our claim with diagnosis V80.09. What should I change when we resubmit?

Arkansas Subscriber

Answer: Typically, neurologists perform skin punch biopsies as a diagnostic study to determine whether the patient has a small fiber neuropathy (or to rule out that possibility) rather than as a screening test. The patient usually has signs/symptoms that make the diagnostic study medically necessary. Small fiber neuropathy is often considered to be one of the major causes of painful burning sensations in the feet, especially in the elderly.

According to ICD-9 Guidelines, "Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease...The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test."

Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a diagnosis has not been established (confirmed) by the neurologist. In this case, you would potentially link 782.0 (Disturbance of skin sensation) to report common patient symptoms of tingling, numbness, pins-and-needles and/or hyperalgesia.

The ICD-9 Guidelines also provide coders with direction when the diagnostic tests have been interpreted and the final report is available at the time of coding to "Code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses." If possible, it may be beneficial to wait until the biopsy results are back and potentially report a confirmed diagnosis, such as 357.2 (Polyneuropathy in diabetes) or 357.6 (Polyneuropathy due to drugs).