Neurosurgery Coding Alert

In ICD-10, you look for individual codes for fracture and spinal injury.

You need to exercise care when reporting cervical fractures with spinal cord lesions. Whereas ICD-9 has a single code for the two together, you may miss out a code in ICD-10 unless you know that you can report for both the fracture as well as the spinal lesion.

ICD-9: When reporting a closed fracture of the cervical vertebrae with a spinal injury, you look at the level of vertebral fracture and confirm whether the spinal injury is an anterior, central or complete lesion.

You may select from codes 806.01 (Closed fracture of C1-C4 level with complete lesion of cord), 806.02 (Closed fracture of C1-C4 level with anterior cord syndrome), or 806.03 (Closed fracture of C1-C4 level with central cord syndrome) for levels C1 to C4. Similarly, you look at codes 806.06 (Closed fracture of C5-C7 level with complete lesion of cord), 806.07 (Closed fracture of C5-C7 level with anterior cord syndrome), or 806.08 (Closed fracture of C5-C7 level with central cord syndrome) for levels C5 to C7. For any other spinal lesions, you report codes 806.04 (Closed fracture of C1-C4 level with other specified spinal cord injury) and 806.09 (Closed fracture of C5-C7 level with other specified spinal cord injury) for levels C1 to C4 and C5 to C7, respectively.

When your surgeon does not specify the type of spinal lesion, you report codes 806.00 (Closed fracture of C1-C4 level with unspecified spinal cord injury) for levels C1 to C4 and 806.05 (Closed fracture of C5- C7 level with unspecified spinal cord injury) for levels C5 to C7.

Note: Spinal injury refers to any complete or incomplete traumatic lesion of the spinal cord or hematomyelia. Other manifestations include nerve injuries, paralysis, paraplegia, quadriplegia, and spinal cord concussion. "There is a group of patients who sustain spinal cord injury without bony injury (AKA spinal cord injury without radiographic abnormality or SCIWORA). A distinct set of diagnosis codes reflect cord injuries not associated with bony injuries," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

ICD-10: When reporting the cervical vertebral fractures with spinal injuries in ICD-10, you need to be specific for each vertebral level. Once you have determined the level, you will note that each ICD-9 code ramifies into two matching ICD-10 codes, one for the fracture and another one for the spinal injury. Another step for you in ICD-10 is to match the vertebral fracture code according to the displaced or nondisplaced fracture.

Step 1: Determine the Spinal Lesion Code

For complete lesions at levels C1 to C4, you report S14.111A (Complete lesion at C1 level of cervical spinal cord, initial encounter), S14.112A (Complete lesion at C2 level of cervical spinal cord, initial encounter), S14.113A (Complete lesion at C3 level of cervical spinal cord, initial encounter), or S14.114A (Complete lesion at C4 level of cervical spinal cord, initial encounter) depending upon the level of the lesion. Hence, you see that ICD-9 code 806.01 maps to 4 codes. Similarly, the code 809.06 maps to S14.115A (Complete lesion at C5 level of cervical spinal cord, initial encounter), S14.116A (Complete lesion at C6 level of cervical spinal cord, initial encounter), and S14.117A (Complete lesion at C7 level of cervical spinal cord, initial encounter).

You follow the same analogy for the anterior and central cord syndromes. You may select from codes S14.131A (Anterior cord syndrome at C1 level of cervical spinal cord, initial encounter), S14.132A (Anterior cord syndrome at C2 level of cervical spinal cord, initial encounter), S14.133A (Anterior cord syndrome at C3 level of cervical spinal cord, initial encounter), S14.134A (Anterior cord syndrome at C4 level of cervical spinal cord, initial encounter), S14.135A (Anterior cord syndrome at C5 level of cervical spinal cord, initial encounter), S14.136A (Anterior cord syndrome at C6 level of cervical spinal cord, initial encounter), and S14.137A (Anterior cord syndrome at C7 level of cervical spinal cord, initial encounter) for anterior cord syndrome.

For central cord syndrome, you turn to codes S14.121A (Central cord syndrome at C1 level of cervical spinal cord, initial encounter), S14.122A (Central cord syndrome at C2 level of cervical spinal cord, initial encounter), S14.123A (Central cord syndrome at C3 level of cervical spinal cord, initial encounter), S14.124A (Central cord syndrome at C4 level of cervical spinal cord, initial encounter), S14.125A (Central cord syndrome at C5 level of cervical spinal cord, initial encounter), S14.126A (Central cord syndrome at C6 level of cervical spinal cord, initial encounter), or S14.127A (Central cord syndrome at C7 level of cervical spinal cord, initial encounter).

For other spinal lesions, you take a similar approach. Code 806.04 maps to codes S14.151A (Other incomplete lesion at C1 level of cervical spinal cord, initial encounter) to S14.154A (Other incomplete lesion at C4 level of cervical spinal cord, initial encounter) and code 806. 09 maps to three codes: S14.155A (Other incomplete lesion at C5 level of cervical spinal cord, initial encounter), S14.156A (Other incomplete lesion at C6 level of cervical spinal cord, initial encounter), and S14.157A (Other incomplete lesion at C7 level of cervical spinal cord, initial encounter).

When your surgeon does not specify the spinal injury, you adopt a parallel approach and report from ICD-10 codes S14.101A (Unspecified injury at C1 level of cervical spinal cord, initial encounter) to S14.107A (Unspecified injury at C7 level of cervical spinal cord, initial encounter).

Step 2: Check for the Vertebral Fracture Code

Each of the ICD-9 codes, 806.00 to 806.04 also map to the following eight vertebral fracture codes:

• S12.000A … Unspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture
• S12.001A … Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture
• S12.100A … Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture
• S12.101A … Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture
• S12.200A … Unspecified displaced fracture of third cervical vertebra, initial encounter for closed fracture
• S12.201A … Unspecified nondisplaced fracture of third cervical vertebra, initial encounter for closed fracture
• S12.300A … Unspecified displaced fracture of fourth cervical vertebra, initial encounter for closed fracture
• S12.301A … Unspecified nondisplaced fracture of fourth cervical vertebra, initial encounter for closed fracture

Similarly, for levels C5 to C7, the ICD-9 codes 806.05 to 806.09 also map to the following fracture codes depending upon the level of the fracture and its displacement.

• S12.400A … Unspecified displaced fracture of fifth cervical vertebra, initial encounter for closed fracture
• S12.401A … Unspecified nondisplaced fracture of fifth cervical vertebra, initial encounter for closed fracture
• S12.500A … Unspecified displaced fracture of sixth cervical vertebra, initial encounter for closed fracture
• S12.501A … Unspecified nondisplaced fracture of sixth cervical vertebra, initial encounter for closed fracture
• S12.600A … Unspecified displaced fracture of seventh cervical vertebra, initial encounter for closed fracture
• S12.601A … Unspecified nondisplaced fracture of seventh cervical vertebra, initial encounter for closed fracture

Tip: Select the fracture code depending upon whether the fracture is a displaced or nondispalced fracture.

ICD-10 coding change: Each code for vertebral fracture with spinal injury in ICD-9 maps to two different code sets in ICD-10, one for the level of vertebral fracture depending upon its displacement and another for the spinal cord lesion (complete, anterior, central, other, and unspecified). Thus, ICD-9 codes 806.00 to 806.04 map to 12 codes each in ICD-10 and codes 806.05 to 806.09 map to 9 codes each in ICD-10. "This is an example of the increased granularity that is typically associated with the tenth modification of ICD," says Przybylski.

Documentation: Make sure your surgeon documents if the precise level and nature of the fracture (displaced or nondisplaced) for the cervical vertebral fracture and spinal injury.

Remember: ICD-9 codes will no longer be accepted for dates of service on or after October 1, 2014. "ICD-10 codes will not be recognized or accepted on claims prior to October 1, 2014. Claims cannot contain both ICD-9 codes and ICD-10 codes," explained Sarah Shirey-Losso from the Provider Billing Group of the Center for Medicare in the "Begin Transitioning to ICD-10 in 2013" National Provider Call on April 18, 2013. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.