Neurosurgery Coding Alert

Laterality is key to subarachnoid hemorrhages and location is key in cervical disc displacement.

Here are answers to the coding quiz for key neurosurgery diagnoses. These will help you assess how well you attempted the quiz. The explanations will give you tips and cues to making your way to the most precise diagnosis codes.

Answer 1: The correct answer is b) I60.00.

For subarachnoid haemorrhage from carotid bifurcation, submit ICD-10-CM code I60.00 (Nontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcation).

Remember: ICD-10-CM is specific for the right and left sided hemorrhages in the carotid circulation. For hemorrhage from the right carotid siphon and bifurcation, submit code I60.01 (Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation), and for the left sided bleed, submit code I60.02 (Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation).

Answer 2: The correct answer is d) M54.17.

When your physician documents a diagnosis of lumbosacral radiculopathy, submit ICD-10 code M54.17 (Radiculopathy, lumbosacral region).

The radiculopathy codes M54.14 (Radiculopathy, thoracic region), M54.15 (Radiculopathy, thoracolumbar region), and M54.16 (Radiculopathy, lumbar region) are specific for the thoracic, thoracolumbar, and lumbar regions, respectively.

Tip: Choose the right code for radiculopathy depending upon the region of the spine involved. “The ICD-10 codes are more granular for describing levels of the spine, often using separate codes to report pathology at junctional levels,” says Gregory Przybylski, MD, interim director of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison Answer 3: The correct answer is c) G93.0.

For cerebral cysts, submit ICD-10-CM code G93.0 (Cerebral cysts). This code applies to ventricular cysts, arachnoid cysts, porencephalic cysts, porencephaly, and acquired pseudoporencephaly.

The codes Q04.6 (Congenital cerebral cysts) and Q04.8 (Other specified congenital malformations of brain) apply to congenital disorders. For congenital cerebral cysts, report code Q04.6 and for other congenital malformations of the brain, you submit code Q04.8. You submit code P91.1 (Acquired periventricular cysts of newborn) for acquired periventricular cysts in a new born.

Answer 4: The correct answer is a) M96.3.

For kyphosis that develops as a sequence to laminectomy procedure, submit the ICD-10-CM code M96.3 (Postlaminectomy kyphosis).

The code M40.00 (Postural kyphosis, site unspecified) applies to kyphosis acquired due to wrong posture and the code Q76.41 (Congenital kyphosis) applies to congenital kyphosis. The code M40.1 (Other secondary kyphosis) applies to kyphosis due to other causes.

Key to kyphosis: When submitting a diagnosis of kyphosis, make sure you know the underlying cause for kyphosis.

Common causes of kyphosis: One of the causes for kyphosis is degeneration, for example, in degenerative arthritis with disc space collapse. Osteopororsis, vertebral fractures, and vertebral trauma are other common causes for kyphosis. Kyphosis can be acquired due to a persistent bad posture. Kyphosis may occur as a consequence of surgical procedures in the spine, for example laminectomy or as a consequence of exposure to radiation. Kyphosis may occur due to other medical conditions, for example, tuberculosis of spine can cause a structural deformity and result in kyphosis. This is called Gibbus deformity.

Developmental kyphosis: Kyphosis may occur due to developmental problems. Scheuermann’s kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. This is a developmental condition, and the cause for this condition is not precisely known.

“In circumstances where there is a clear diagnosis responsible for the kyphosis, it is recommended to additionally report the cause of the kyphosis,” Przybylski says.

Answer 5: The correct answer is d) M50.00.

All the codes listed in the choices for this question are codes that apply to cervical disc displacement. The question does not state the precise location of the displacement in the cervical spine region. With this available information, the most accurate code is M50.20 (Other cervical disc displacement, unspecified cervical region) for cervical disc displacement.

Check level in displacement of cervical disc: For the right ICD-10-CM code for cervical disc displacement, you should specify the precise location of the displacement in the cervical region. Check the clinical note for high or mid cervical, or displacement at the cervicothoracic region. Accordingly, you submit ICD-10 codes M50.21 (Other cervical disc displacement, high cervical region), M50.22 (Other cervical disc displacement, mid-cervical region), or M50.23 (Other cervical disc displacement, cervicothoracic region).

“This is another example of the increased granularity of the ICD-10 codes when compared with ICD-9,” Przybylski says.