Neurosurgery Coding Alert

Report the myelopathy, ganglionitis, neuropathy, and unspecified neurological complications.

You may be faced with a situation where the neurological complication after an episode of herpes zoster may involve a nerve, a ganglion, or a segment of the spinal cord. And you may encounter patients with localized numbness and even conditions like a hemiplegia. Read on to know what changes you can expect when reporting postherpetic neurological complications in ICD-10.

Code 053.1x for other nervous system complications in Herpes zoster, encompasses six codes in ICD-9 (053.10 to 053.19). These complications refer to conditions other than meningitis in Herpes zoster.

Complications in Herpes zoster

Neurological complications in Herpes zoster are common of which meningitis is a major complication. Meningitis in Herpes zoster is reported with ICD-9 code 053.0 (Herpes zoster with meningitis). This corresponds to code B02.1 (Zoster meningitis) in ICD-10.

There are many other neurological complications possible with Herpes zoster; these include polyneuropathy, myelitis, and ganglionitis. There are other conditions of the nervous system that do not fall under these categories and are collectively reported as 'other' or 'unspecified'.

ICD-9/ICD-10 Crosswalk

Look at the table below and compare the codes for neurological complications of Herpes zoster.

A one-on-one of codes in ICD-9 and ICD-10 reflect some changes in ICD-10 in codes for these conditions.

1. Codes 053.10 and 053.19 in ICD-9 match to code B02.29.

2. Codes 053.11 and 053.14 have a change in terminology from 'Herpes zoster' to 'Postherpetic'.

3. Codes 053.12 and 053.13 reflect no change in descriptors.

Get Specific in ICD-10

In codes B02.29, B02.21, and B02.24, there is a change in descriptor from 'Herpes zoster' in the ICD-9 descriptors to 'postherpetic' in the ICD-10 descriptors.

The complications like myelitis, geniculate ganglionitis, and other nervous system involvements develop after the rash of the herpetic infection. Hence, the ICD-10 descriptors are more precise. "Notice that the ICD-10 descriptors list "post-herpetic" neurological complications. While these can occur related to Herpes zoster, these can also result from non-zoster herpetic infections (eg Herpes simplex virus)," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Learn From Examples

Take a look at the scenarios below for the neurological complications in Herpes zoster and find out how you'll narrow down to the correct code for these conditions in ICD-10.

Example 1: If you read that the patient developed a hemiparesis following an episode of Herpes zoster infection, you will turn to code B02.29 in ICD-10. This clearly does not fall in any other specific category of complications.

Example 2: If your physician reports an erythematous vesicular rash around the ear and a mucosal rash in the oropharynx along with a facial palsy with a lateral shift in the angle of the mouth, you confirm that this is a diagnosis of geniculate ganglionitis. You may also see that the patient also reported nystagmus or tinnitus. In this case, you report ICD-10 code B02.21.

Example 3: If you read that the patient complained of pain in the jaw and cheeks and reported electric shock-like stabs subsequent to having developed a skin rash in the past, you confirm that the trigeminal nerve has been affected and report B02.22.

Example 4: If a patient who had a herpetic rash complains of numbness in the segment of the lateral thigh, you report an otherwise unspecified neurological complication with code B02.29.

Example 5: If the clinical note specifies that 'a week after the appearance of skin rash, the patient noticed progressive weakness in right hand and there was also a difficulty in raising right arm above the shoulder', you confirm a cervical myelopathy and report code B02.24. "One would expect to see MRI evidence of abnormal cervical cord signal consistent with the location of the arm weakness," says Przybylski.