Neurosurgery Coding Alert

Confirm the type of cerebral palsy to narrow down to correct code.

What looks like a direct mapping to ICD-10 codes for cerebral palsy may actually leave you perplexed, as the codes will center on the basic classification of the condition in 2014. Another challenge is to distinguish cerebral palsy form other palsies that may or may not hereditary. Learn what ICD-10 options have to offer in 2014.

Get Your Basics Clear

Before you can report the diagnosis of cerebral palsy, you should have clarity on what actually the term refers to. This will help you to avoid confusion with codes for other hereditary palsies and the nonhereditary spastic palsies.

What is cerebral palsy? Cerebral palsy refers to non-progressive conditions in which body movements are affected resulting in physical disability. A lesion or defect in the brain causes motor dysfunction affecting muscle tone, posture, and movement. Reflexes and coordination are also affected. Affected children also show disorders of gait, eating, learning, and intellect. The dysfunction affects young children and may set in at or soon after birth. “This condition can affect one or more limbs, leading to a spectrum of impairments,” says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Types of cerebral palsy: Cerebral palsy is of four major types: Spastic, ataxic, athetoid/dyskinetic and mixed.

ICD-10 is type specific: As you run through the codes below, you will notice that ICD-10 has options for cerebral palsy that are more type specific. This means that you need to ensure that your physician documents the type of cerebral palsy specifically in the clinical note.

Be Prepared For Specific Descriptors

One change that you will encounter in the ICD-10 codes for cerebral palsy is that the code descriptors clearly specify ‘cerebral palsy.’ Thus, cerebral palsy gains identity in the ICD-10 options.

When your physician documents spastic cerebral palsy affecting two limbs, you report code 343.0 (Congenital diplegia). The ICD-10 code corresponding to 343.0 is G80.1 (Spastic diplegic cerebral palsy).

Also, note that the ICD-10 code G80.1 clearly defines the spastic type of cerebral palsy. You cannot submit the same code for athetoid, mixed, or other types of cerebral palsies.

In ICD-9, the descriptors are not as specific. Other terms in the documentation that will help you to zero in for the codes for cerebral plasy include ‘spastic infantile paralysis,’ congenital cerebral spastic paralysis,’ and ‘spastic paralysis due to birth injury.’ You also report code 343.0 for Little’s disease. The ICD codes for cerebral palsy are inclusive of the Little’s disease. Little’s disease is a type of spastic cerebral palsy marked by spastic diplegia. The legs are typically more severely affected than the arms.

You No Longer Distinguish Congenital and Infantile Hemiplegia

For congenital hemiplegia, you report ICD-9 code 343.1 (Congenital hemiplegia), which corresponds to code G80.2 (Spastic hemiplegic cerebral palsy) in ICD-10. You do not report ICD-9 code 343.1 for infantile hemiplegia as ICD-9 has a specific option for this condition. If your physician documents the hemiplegia in a child aged less than 1 year in age, you turn to ICD-9 code 343.4 (Infantile hemiplegia). This code also corresponds to ICD-10 code G80.2.

You do not need to confirm if the hemiplegia had an onset at birth or in the first year of life. This is because both the options in ICD-9, i.e. 343.1 and 343.4 map to a common ICD-10 code i.e. G80.2.

Spot Direct Codes for Hemiplegic and Monoplegic Palsies

For spastic cerebral palsy that leads to quadriplegia, you report ICD-9 code 343.2 (Congenital quadriplegia). This corresponds to ICD-10 code G80.0 (Spastic quadriplegic cerebral palsy). If the cerebral palsy affects only one limb, you report code 343.3 (Congenital monoplegia) in ICD-9. The corresponding ICD-10 code is G80.8 (Other cerebral palsy).

You do not have a very specific option for congenital monoplegia in ICD-10 as this is classified as ‘other cerebral palsy’ in ICD-10.

ICD-10 Gets Specific for Ataxic Cerebral Palsy

For any other type of cerebral palsy that your physician reports, you can submit ICD-9 code 343.8 (Other specified infantile cerebral palsy). There are two corresponding ICD-10 codes:

• G80.8, Other cerebral palsy
  
• G80.4, Ataxic cerebral palsy
  

Thus, you see that in ICD-10, you have a discrete and specific code for ataxic cerebral palsy.

Do Not Miss the Unspecified Cerebral Palsy

You have a simple one-to-one match for the unspecified type of cerebral palsy. When your physician does not specify the type of cerebral palsy, you report ICD-9 code

343.9 (Infantile cerebral palsy unspecified). This maps to G80.9 (Cerebral palsy, unspecified) in ICD-10.

Look for Discrete Option for Athetoid Palsy

Athetoid cerebral palsy has a specific code 333.71 (Athetoid cerebral palsy). The corresponding ICD-10 code is G80.3 (Athetoid cerebral palsy). This is another example of a direct mapping.

Note: Athetoid cerebral palsy is also called double athetosis.

Watch for Other Similar Conditions

The codes for cerebral palsy are not applicable to hereditary cerebral paralysis. You have different set of codes for hereditary paralysis. For hereditary spastic paraplegia, you report ICD-9 code 334.1 (Hereditary spastic paraplegia). The corresponding ICD-10 code is G11.4 (Hereditary spastic paraplegia).

Also note that you have a different set of codes for spastic paralysis specified as noncongenital or noninfantile. You can look at ICD-9 codes 344.0 (Quadraplegia and quadraparesis) - 344.9 (Paralysis unspecified).