Neurosurgery Coding Alert

Be specific for spinal cord, cauda equina, and meninges.

When reporting a diagnosis of a malignant tumor in the spinal cord or meninges, you have simple yet specific choices in ICD-10. With easy to implement options, you can ensure you clear any hurdles in getting your payment.

Distinguish Between Cord and Meninges

When your surgeon treats a spinal tumor, make sure you know which structure in the spine is actually involved. For malignant tumors of the spinal cord, you report ICD-9 code 192.2 (Malignant neoplasm of spinal cord).

In ICD-10, the code 192.2 corresponds to two codes, i.e. C72.0 (Malignant neoplasm of spinal cord) and C72.1 (Malignant neoplasm of cauda equina).

Tip: ICD-10 is more specific for spinal cord tumors as you have distinct codes for the spinal cord and the cauda equina. In ICD-9, the code 192.2 is inclusive of the cauda equina tumors.

“Malignant tumors of the spinal cord and cauda equina are typically glioblastoma and malignant ependymoma respectively. Metastatic neoplasms can also be rarely seen,” says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

What is cauda equina? Cauda equina is the bundle of spinal nerves and spinal nerve roots that originate in the tip of the spinal cord. This bundle consists of nerve pairs that originate from second lumbar level to fifth sacral level, and the coccygeal nerve. This bundle has both sensory and motor nerves and supplies the pelvic organs, perineum, and lower limbs.

Remember that these codes imply malignant tumors in the spinal cord. For malignant tumors in the meningeal coverings of the spinal cord, you report codes for spinal meninges, i.e. code 192.3 (Malignant neoplasm of spinal meninges) in ICD-9. “Fortunately, most spinal cord neoplasms are benign, including astrocytoma and ependymoma,” says Przybylski.

Be Specific For Cerebral and Spinal Meninges

In ICD-9, you report malignant neoplasms of meninges, depending upon whether your physician is treating meningeal neoplasms in the brain or the spinal cord. You report 192.1 (Malignant neoplasm of cerebral meninges) and 192.3 for malignant neoplasms of the cerebral and spinal meninges, respectively.

When reporting for the same in ICD-10, you retain your focus on the cerebral or spinal location of the meningeal neoploasms. ICD-9 code 192.1 corresponds to ICD-10 codes C70.0 (Malignant neoplasm of cerebral meninges) and C70.9 (Malignant neoplasm of meninges, unspecified). Similarly, ICD-9 code for spinal meningeal neoplasms (192.3) corresponds to ICD-10 code C70.1 (Malignant neoplasm of spinal meninges).