Neurosurgery Coding Alert

Cause is important in congenital aneurysms, location in others.

When reporting nonruptured cerebral aneurysms in ICD-10, you’ll be on easy street as long as you can confirm the aneurysm in the carotid artery.

When submitting a diagnosis code for an intracranial aneurysm that is not ruptured, you report ICD-9 code 437.3 (Cerebral aneurysm nonruptured). This code applies for aneurysms in the intracranial portions of the internal carotid artery. The corresponding ICD-10 code is 167.1 (Cerebral aneurysm, nonruptured).

When the aneurysm is in the other extracranial segments of the carotid artery, i.e., common carotid artery, external carotid artery, or extracranial portion of the internal carotid artery, you report ICD-9 code 442.81 (Aneurysm of artery of neck). The corresponding ICD-10 code is I72.0 (Aneurysm of carotid artery). Though the ICD-10 code 172.0 is more specific as it mentions that the aneurysm is in the carotid artery, it does not clearly state where the aneurysm is located.

Tip: Make sure your surgeon clearly documents the anatomical location of the aneurysm in the internal carotid artery. When your surgeon does not document the location specifically, you report ICD-9 code 437.3 or the corresponding ICD-10 code 167.1.

Check the Cause for Congenital Aneurysms

For congenital aneurysms in the cerebral circulation, you report ICD-9 code 747.81 (Congenital anomalies of cerebrovascular system). This code applies to the arteriovenous malformations in the brain, congenital cerebral arteriovenous associated with aneurysms, and any other congenital anomalies of cerebral vessels.

There are two corresponding ICD-10 codes for 747.81. These include Q28.2 (Arteriovenous malformation of cerebral vessels) and Q28.3 (Other malformations of cerebral vessels). When reporting ICD-10 codes for congenital aneurysms, you will need your surgeon to confirm the cause for the aneurysm. When the aneurysm is associated with an arteriovenous malformation, you report Q28.2. For any other underlying cause, for example, aneurysms associated with congenital collagen disorders or other genetic syndromes, you report ICD-10 code Q28.3.

Note: There are no specific codes for ruptured intracranial aneurysms. You report ICD-9 code 430 (Subarachnoid hemorrhage). This code applies to ruptured berry aneurysms and ruptured congenital cerebral aneurysms.