Neurosurgery Coding Alert

Don’t miss new codes for hereditary cerebrovascular diseases.

CMS recently published its list of the new ICD-10 2019 codes, but they won’t go into effect until Oct. 1, 2018. Read on to learn how these 280 new codes and 170 revisions may impact your neurosurgery practice’s bottom line.

Mark Down These Cerebral Infarction Additions and Revisions

Additions: The category I63- (Cerebral infarction) will add the following new codes:

• I63.81 (Other cerebral infarction due to occlusion or stenosis of small artery)
• I63.89 (Other cerebral infarction).

Don’t miss: An ICD-10 instructional note under category I63- tells you to report an additional code, if applicable, to identify status post administration of tPA (rtPA) in a different facility with the last 24 hours prior to the patient’s admission to the current facility (Z92.82).

Also, if applicable, you should report an additional code to indicate the patient’s National Institutes of Health Stroke Scale (NIHSS) score (R29.7-).

Revisions: Along with the additions, you’ll also see changes to I63.219 (Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery) and I63.239 (… unspecified carotid artery). In both descriptors, the current word “arteries” has changed to “artery.”

Revisions: Additionally, the following code descriptors have seen a slight change (emphasis added):

• I63.333 (Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries)
• I63.343 (Cerebral infarction due to thrombosis of bilateral cerebellar arteries).

You will note that that word “due” has been added to the code descriptors.

Highlight New Subcategory Under Category I67-

Category I67- (Other cerebrovascular diseases) will add the new subcategory I67.85- (Hereditary cerebrovascular diseases) to your coding arsenal. Under that subcategory, you will find the following new codes.

• I67.850 (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy).
• I67.858 (Other hereditary cerebrovascular disease).

Don’t miss: Under I67.850 (Other cerebrovascular diseases) there is a new “code also” note that instructs you to also report any associated diagnoses such as epilepsy and recurrent seizures (G40.-); cerebral infarction (I63.-); and vascular dementia (F01.-).

Look for Clonic Hemifacial Spasm Updates

Additions: Subcategory G51.3- (Clonic hemifacial spasm) will add the following four new codes:

• G51.31 (Clonic hemifacial spasm, right)
• G51.32 (Clonic hemifacial spasm, left)
• G51.33 (Clonic hemifacial spasm, bilateral)
• G51.39 (Clonic hemifacial spasm, unspecified).

“These conditions are often thought to be related to vascular compression of the seventh cranial nerve at the brainstem,” says Gregory Przybylski, MD, past chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

“You may see this condition treated with suboccipital craniectomy for microvascular decompression of the facial nerve reported with 61458 (Craniectomy, suboccipital; for exploration or decompression of cranial nerves).

Find Additions to Muscular Dystrophy Dx

Additions: ICD-10 2019 will also add to subcategory G71.0- (Muscular dystrophy). Your four new choices are as follows:

• G71.00 (Muscular dystrophy, unspecified)
• G71.01 (Duchenne or Becker muscular dystrophy)
• G71.02 (Facioscapulohumeral muscular dystrophy)
• G71.09 (Other specified muscular dystrophies).

Notice These External Cause Code Changes

T codes are part of Chapter 19, Injury, poisoning and certain other consequences of external causes. Here are some areas to note from the T code additions and changes:

Ecstasy poisoning additions: Watch for options to report ecstasy poisoning under new subcategory T43.64- (Poisoning by ecstasy). Your new choices are as follows:

• T43.641X (Poisoning by ecstasy, accidental (unintentional))
• T43.642X (Poisoning by ecstasy, intentional self-harm)
• T43.643X (Poisoning by ecstasy, assault)
• T43.644X (Poisoning by ecstasy, undetermined).

Don’t miss: Codes in category T43- (Poisoning by, adverse effect of and underdosing of psychotropic drugs, not else classified) require a seventh character. Your choices are as follows:

• A (Initial encounter)
• D (Subsequent encounter)
• S (Sequela).

Caution: Don’t forget about notes with codes. For example, T74.3 (Psychological abuse, confirmed) has new notes clarifying that the code is appropriate for “Bullying and intimidation, confirmed” and “Intimidation through social media, confirmed.”

Confirmed forced labor/sexual exploitation additions: Check for new code additions specific to confirmed forced labor and forced sexual exploitation. These codes include T74.5- (Forced sexual exploitation, confirmed) through T74.62XS (Child forced labor exploitation, confirmed, sequela). Instructions with codes from category T74- (Adult and child abuse, neglect and other maltreatment, confirmed) tell you to report an additional code, if applicable to identify any associated current injury. You should also report an additional external cause code to identify the perpetrator if known (Y07.-).

Suspected forced labor/sexual exploitation additions: You will also see new codes for suspected forced labor and forced sexual exploitation T76.5- (Forced sexual exploitation, suspected) through T76.62XS (Child forced labor exploitation, suspected, sequela). Instructions with codes from category T76- (Adult and child abuse, neglect and other maltreatment, suspected) tell you if applicable to report an additional code to identify any associated current injury.

Infection and sepsis additions: Notice that codes T81.40- (Infection following a procedure, unspecified) through T81.43XS (Infection following a procedure, organ and space surgical site, sequela) and T81.49XX (Infection following a procedure, other surgical site) added to category T81- (Complications of procedures, not elsewhere classified). And, don’t miss new sepsis code T81.44XX (Sepsis following a procedure).

Adopt These New Z Codes

Z codes are part of Chapter 21, Factors influencing health status and contact with health services. Z codes represent reasons for encounter, and you must report a corresponding procedure code with a Z code if the physician performs the procedure, according to ICD-10 instructions.

ICD-10 2019 will add multiple Z codes you need to be aware of including Z04.81 (Encounter for examination and observation of victim following forced sexual exploitation); Z13.3 (Encounter for screening examination for mental health and behavioral disorders); Z20.821 (Contact with and (suspected) exposure to Zika virus); and Z62.813 (Personal history of forced labor or sexual exploitation in childhood).