Neurology & Pain Management Coding Alert

Learn how coding signs and symptoms may raise reimbursement

If you-re faced with assigning diagnosis codes during EEG seizure monitoring, you-ve likely encountered frustration in the chasm between current medical terminology for seizures and ICD-9 definitions. Use some of these expert tips to help overcome frustration and bridge the language gap. 1. Translate Chart Terminology Epileptologists have spent many years lamenting the limitations of ICD-9's descriptions for epilepsy conditions. -ICD-9 is at least one generation behind, and it's based on a very old understanding of epilepsy,- says Paul M. Levisohn, MD, practice committee chair of the American Epilepsy Society and associate professor of neurology and pediatrics at the University of Colorado Health Sciences Center in Denver.  

But coding a diagnosis to the highest level of specificity is not impossible if you learn to read between the codes.

Terms such as -myoclonic,- -absence- or -partial seizures- may crop up frequently in documentation but appear to be missing from epilepsy code definitions (345.xx). You can get some clarity, however, if you take notice of the terminology below each code's definition, which provides -keywords- that can also refer you to an appropriate diagnosis.

Example: Your neurologist documents a patient presenting with myoclonic epileptic seizures, but you can't find an epilepsy code specifically for this category. Reading through the descriptions following each code, however, you spot myoclonic epileptic seizures under 345.1x (Generalized convulsive epilepsy).  

Use your ABCs: If you-re still stuck with a tough term, you may be able to translate your doctor's description into a diagnosis code using the epilepsy listing in ICD-9's alphabetical index.

For example, if you use the index to look up epileptic seizures caused by cysticercosis, you-ll be directed to 123.1 (Cysticercosis), a code you never would have found combing through the 345 range.

2. Don't Fear Unspecified Codes Although you may face challenges translating the language in a patient's chart into ICD-9 definitions, you-ll also likely encounter situations when you just don't have enough information to arrive at a specific diagnosis. 

Patients experiencing seizures will often need to undergo EEG monitoring to pinpoint the reasons and to help neurologists localize the portion of the brain affected. In other words, a final diagnosis is most often undetermined at the time of monitoring.

Many coders try to avoid assigning unspecified diagnoses at all costs. But when a definitive diagnosis is not available, you can feel comfortable using unspecified codes to diagnose the patient's seizure activity. Most frequently, coders will look to 345.9x (Epilepsy, unspecified) or 780.39 (Other convulsions).

Even when a neurologist arrives at a specific diagnosis, you may still not be able to report the patient's condition with any current ICD-9 definitions. In such cases, consider using 345.8x (Other forms of epilepsy).

Examples: Diagnoses such as [...]