Neurosurgery Coding Alert

Pay attention to site and side of the hemorrhage.

You may find it confusing to move from one code in ICD 9 to 20 codes in ICD 10 for nontraumatic subarachnoid hemorrhage. The ICD 9 code 430 (Subarachnoid hemorrhage) is just a concise choice for a subarachnoid hemorrhage, irrespective of where and which side the hemorrhage occurred. Read on for the ICD 10 expansion details.

Determine the Site of the Bleed

Your first guide to the right code for subarachnoid hemorrhage which is not a consequence of trauma is to determine the site the bleed in the cerebral circulation. Your first step is to determine if the site of the bleed was the vertebral artery, basilar artery, anterior or posterior communicating artery, middle cerebral artery, carotid artery, or other intracranial arteries.

"This will provide greater specificity regarding the location of the aneurysmal hemorrhage and facilitate tracking of treatment and outcomes specific to the location," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison. "The current CPT® codes only distinguish anterior and posterior circulation aneurysms, precluding easier and more accurate tracking of outcomes for the specific location."

Confirm If the Bleed Was Left or Right Sided

The next important step is to check in the clinical note if the hemorrhage was on the right or the left side of the head. "Challenges can be faced identifying the side with midline subarachnoid hemorrhage that can be seen with anterior communicating artery subarachnoid hemorrhages," says Przybylski.

If, however, your surgeon does not mention the side of the hemorrhage, you may report the unspecified codes for different sites.

Pick Up A Specific Code

The ICD 10 codes for nontraumatic subarachnoid hemorrhage from the carotid circulation include I60.00 (Nontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcation), I60.01 (Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation), and I60.02 (Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation). The code for the basilar artery is I60.4 (Nontraumatic subarachnoid hemorrhage from basilar artery) and those for the vertebral arteries are I60.50 (Nontraumatic subarachnoid hemorrhage from unspecified vertebral artery), I60.51 (Nontraumatic subarachnoid hemorrhage from right vertebral artery), and I60.52 (Nontraumatic subarachnoid hemorrhage from left vertebral artery).

The codes for the middle cerebral and communicating arteries include I60.10 (Nontraumatic subarachnoid hemorrhage from unspecified middle cerebral artery), I60.11 (Nontraumatic subarachnoid hemorrhage from right middle cerebral artery), I60.12 (Nontraumatic subarachnoid hemorrhage from left middle cerebral artery), I60.20 (Nontraumatic subarachnoid hemorrhage from unspecified anterior communicating artery), I60.21 (Nontraumatic subarachnoid hemorrhage from right anterior communicating artery), I60.22 (Nontraumatic subarachnoid hemorrhage from left anterior communicating artery), I60.30 (Nontraumatic subarachnoid hemorrhage from unspecified posterior communicating artery), I60.31 (Nontraumatic subarachnoid hemorrhage from right posterior communicating artery) and I60.32 (Nontraumatic subarachnoid hemorrhage from left posterior communicating artery).

If the bleed is from a vessel other than the major vessels then you turn to code I60.6 (Nontraumatic subarachnoid hemorrhage from other intracranial arteries). Sometimes, the clinical note may not specify the location of the bleed or the same may be difficult to determine. In this case, you report code I60.7 (Nontraumatic subarachnoid hemorrhage from unspecified intracranial artery).

When your surgeon neither specifies the site nor the side of the hemorrhage, you may turn to code I60.9 (Nontraumatic subarachnoid hemorrhage, unspecified).

Note: One important change that ICD 10 will introduce is that it clearly specified that the subarachnoid hemorrhage in nontraumatic in nature. "However, ICD 9 does include a section of traumatic head injury codes in which subarachnoid hemorrhage is also identified as a component," says Przybylski.