Neurosurgery Coding Alert

Check all options you have before selecting a single code.

When reporting ICD-10 codes for central demyelinating disorders, you can be easily confused as some codes have a direct match, whereas others either narrow down to a single code or span to match multiple codes. Make sure you check out all possible codes before you pick up the best one you can report.

Apply One-To-One Match for 2 Conditions

Multiple sclerosis has a direct matching code in ICD-10. In ICD-9, you report 340 (Multiple sclerosis) and the corresponding ICD-10 code is G35 (Multiple sclerosis). These codes apply to multiple sclerosis of brain stem, spinal cord, generalized multiple sclerosis, and the non-specified conditions as well.

The ICD-9 and ICD-10 codes for neuromyelitis optica are 341.0 (Neuromyelitis optica) and G36.0 (Neuromyelitis optica [Devic]), respectively. The descriptor of the ICD-10 code G36.0 includes the term ‘Devic’ which is a synonym for neuromyelitis optica.

Differentiate By Type for Sclerosis

For a patient with Schilder’s disease, a demyelinating disorder of childhood, you’ll report ICD-9 code 341.1 (Schilder’s disease) for both the concentric and diffuse sclerosis in the central nervous system. ICD-10, however, offers more specific codes for these two conditions. For diffuse sclerosis, you report code G37.0 (Diffuse sclerosis of central nervous system) and for concentric sclerosis you report code G37.5 (Concentric sclerosis [Balo] of central nervous system).

Narrow Down To Single Code for Transverse Myelitis

You need to choose from three ICD-9 codes for transverse myelitis, i.e., 341.20 (Acute [transverse] myelitis NOS), 341.21 (Acute [transverse] myelitis in conditions classified elsewhere), and 341.22 (Idiopathic transverse myelitis).

Whether the cause for myelitis was idiopathic or unspecified guides your choice of the correct code. In ICD-10, all these three codes map to a single code, i.e. G37.3 (Acute transverse myelitis in demyelinating disease of central nervous system).

“While ICD-10 has generally sought to be more granular and descriptive than ICD-9, this is an unusual example of the opposite,” says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Code 341.8 Maps to Several Codes in ICD-10

When reporting other demyelinating disorders of the central nervous system, you have several codes to choose from in ICD-10. Your choice of the correct code will be guided by the affected structure or any associated inflammation, i.e. myelitis or leukoencephalitis.

You may choose from codes G37.1 (Central demyelination of corpus callosum), G37.2 (Central pontine myelinolysis), G36.1 (Acute and subacute hemorrhagic leukoencephalitis [Hurst]), and G37.4 (Subacute necrotizing myelitis of central nervous system). You may also look at G37.8 (Other specified demyelinating diseases of central nervous system) or G36.8 (Other specified acute disseminated demyelination). IN ICD-9 however, you have no choice but to report 341.8 (Other demyelinating diseases of central nervous system) for these conditions.

Check Severity of Unspecified Demyelinating Conditions

The ICD-9 code 341.9 (Demyelinating disease of central nervous system unspecified) maps to two ICD-10 codes, G37.9 (Demyelinating disease of central nervous system, unspecified) and G36.9 (Acute disseminated demyelination, unspecified). As the descriptors of these codes read, you select G36.9 for unspecified acute disseminated demyelination.