Neurosurgery Coding Alert

Blast-wave injuries get big Dx bump.

Last month, we examined a bevy of new diagnosis codes that neurosurgery coders will need to learn before ICD-10 2023 takes effect on Oct. 1, 2022.

This month … we have more codes to discuss. As the last issue of Neurosurgery Coding Alert showed, brain and intracranial injury coding is about to get much more specific.

Read on for more information on the details for these new diagnosis codes.

Use These New Codes for This Neuro Disorder

In the code category F06.- (Other mental disorders due to known physiological condition), you’ll find the new code F06.7 (Mild neurocognitive disorder due to known physiological condition). This new code, in turn, leads you to these new codes:

• F06.70 (Mild neurocognitive disorder due to known physiological condition without behavioral disturbance)
• F06.71 (Mild neurocognitive disorder due to known physiological condition with behavioral disturbance)

Impact: Previously, you’d have coded mild cognitive disorder due to known physiological condition with F06.8 (Other specified mental disorders due to known physiological condition).

ICD-10 Introduces New Encephalopathy Dx

Another new code you’ll want to note is for a nervous system condition caused by liver dysfunction: K76.82 (Hepatic encephalopathy).

According to Cleveland Clinic, “hepatic encephalopathy is a nervous system disorder brought on by severe liver disease. When the liver doesn’t work properly, toxins build up in the blood. These toxins can travel to the brain and affect brain function.”

Impact: Previously, you would have coded hepatic encephalopathy with K76.89 (Other specified diseases of liver).

Blast-Wave Injury Gets Big Code Bump

In 2023 the S06.8 – (Other specified intracranial injuries) code set will feature a new injury category for injuries caused by blast waves: blast injury of brain, not elsewhere classified (NEC). There are too many new codes to list under the new blast injury classification, but the new codes will account for:

• With/without loss of consciousness,
• Time frame if there is loss of consciousness (from less than 30 minutes all the way to up to greater than 24 hours),
• Survival status (Did the patient die during their loss of consciousness caused by the brain blast?), and
• Status of encounter for blast injury treatment (initial, subsequent, sequela).

Example: Here’s a breakdown of one of the new code sets within S06.8-. ICD-10 first lists new code S06.8A (Primary blast injury of brain, not elsewhere classified).

From there, you’ll have the following new codes to choose from:

• S06.8A0 (Primary blast injury of brain, not elsewhere classified without loss of consciousness)
• S06.8A0A (Primary blast injury of brain, not elsewhere classified without loss of consciousness, initial encounter)
• S06.8A0D (Primary blast injury of brain, not elsewhere classified without loss of consciousness, subsequent encounter)
• S06.8A0S (Primary blast injury of brain, not elsewhere classified without loss of consciousness, sequela)

ICD-10 2023 offers similar — if not identical — 7th character options for each of these new codes:

• S06.8A1 (Primary blast injury of brain, not elsewhere classified with loss of consciousness of 30 minutes or less)
• S06.8A2 (Primary blast injury of brain, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes)
• S06.8A3 (Primary blast injury of brain, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes)
• S06.8A4 (Primary blast injury of brain, not elsewhere classified with loss of consciousness of 6 hours to 24 hours)
• S06.8A5 (Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level)
• S06.8A6 (Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving)
• S06.8A7 (Primary blast injury of brain, not elsewhere classified with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness)
• S06.8A (Primary blast injury of brain, not elsewhere classified with loss of consciousness of any duration with death due to other cause prior to regaining consciousness)
• S06.8A9 (Primary blast injury of brain, not elsewhere classified with loss of consciousness of unspecified duration)
• S06.8AA (Primary blast injury of brain, not elsewhere classified with loss of consciousness status unknown)

Impact: Blast-wave brain injury diagnosis coding goes from quite nebulous to super-specific—and with good reason. Treatments for these injuries are improving, and they’re being recognized and diagnosed in more patients—so making their code set more robust was a natural move for ICD-10.

Unknown Loss of Consciousness Status? Look to These New Codes

In the code set S06.89- (Other specified intracranial injury), you’ll find the following new codes:

• S06.89A (Other specified intracranial injury with loss of consciousness status unknown)
• S06.89AA (Other specified intracranial injury with loss of consciousness status unknown, initial encounter)
• S06.89AD (Other specified intracranial injury with loss of consciousness status unknown, subsequent encounter)
• S06.89AS (Other specified intracranial injury with loss of consciousness status unknown, sequela)

Impact: Adds “loss of consciousness status unknown” and encounter type to the S06.89- code set.

ICD-10 Adds a Bit to S06.9X-

ICD-10 will add these new codes to the S06.9X- (Unspecified cranial injury) code set:

• S06.9XA (Unspecified intracranial injury with loss of consciousness status unknown)
• S06.9XAA (Unspecified intracranial injury with loss of consciousness status unknown, initial encounter)
• S06.9XAD (Unspecified intracranial injury with loss of consciousness status unknown, subsequent encounter)
• S06.9XAS (Unspecified intracranial injury with loss of consciousness status unknown, sequela)

Impact: Adds “loss of consciousness status unknown” and encounter type to this code set.