Neurosurgery Coding Alert

Look at associated symptoms until your physician gets to the final diagnosis. 

Though ICD-10 offers a direct one-to-one match for multiple sclerosis, you have to keep options open to report symptoms. This is because it may take a while for your physician to establish the definitive diagnosis of multiple sclerosis. Take this opportunity to refresh your memory on what multiple sclerosis is, how it affects patients, and how you should determine the correct diagnoses.

ICD-10 Offers a 3-Digit Choice

The diagnosis code for multiple sclerosis is an example where both ICD-9 and ICD-10 offer 3-digit code options.

ICD-9: In ICD-9, you submit code 340 (Multiple sclerosis) when your physician makes a diagnosis of multiple sclerosis. This code includes disseminated or multiple sclerosis. Your physician might document multiple sclerosis NOS, generalized, or related to the brain stem or spinal cord.

Look ahead to ICD-10: When ICD-10 becomes effective in October 2015, you’ll find that multiple sclerosis has a direct matching code: G35 (Multiple sclerosis). The new code will still apply to multiple sclerosis of brain stem, spinal cord, generalized multiple sclerosis, and the non-specified conditions as well. Also note that G35 is an example of how ICD-10 will include some three-digit codes just as ICD-9 does. The majority of ICD-10 codes will have more characters, but don’t be surprised when you find a valid three-digit choice.

“Just as with ICD-9, ICD-10 will include a variety of 3-5 digit codes depending on the granularity of the diagnosis.  The obvious significant difference is the inclusion of alphanumeric codes to replace the prior numeric only codes,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison. 

Code Symptoms Leading to Diagnosis 

A diagnosis of multiple sclerosis requires evidence of at least two areas of damage in the central nervous system that have occurred at different times. Until your physician is able to confirm a diagnosis, you’ll code the patient’s care based on the symptoms exhibited. 

“A common initial symptom is transient visual loss, but other symptoms may include transient weakness or numbness,” Przybylski says.

The National Multiple Sclerosis Society’s website lists a wide range of possible symptoms. Some of the more common include: 

• Fatigue that significantly interferes with daily life activities (780.79, Other malaise and fatigue)
• Walking (gait) difficulties (781.2, Abnormality of gait)
• Numbness or tingling in the face, body, or extremities (782.0, Disturbance of skin sensation)
• Muscle weakness (728.87, Muscle weakness [generalized]) 
• Spasticity (781.0, Abnormal involuntary movements)
• Bladder dysfunction (596.59, Other functional disorder of bladder)
• Pain syndromes (such as 338.0, Central pain syndrome, 338.29, Other chronic pain, or 338.4, Chronic pain syndrome). 

Less common symptoms of MS can be: 

• Difficulty swallowing (787.20, Dysphagia, unspecified)
• Speech problems, including slurring (784.51, Dysarthria) and loss of volume (784.42, Dysphonia) 
• Tremors (such as 781.0 or 728.85, Spasm of muscle)  
• Seizures (780.39, Other convulsions). 

Tie In Associated Conditions

Because multiple sclerosis affects the nervous system, patients often need treatment for problems associated with multiple sclerosis. When that’s the case, list the current condition in addition to the multiple sclerosis diagnosis. 

Example: A patient is experiencing acute exacerbation of her multiple sclerosis, including increased gait problems and difficulty performing activities of daily living. She was previously diagnosed with neurogenic bladder. Your provider will be seeing her to draw blood to assess the new medication she started a few weeks ago. He also will complete a neurological assessment and change her Foley catheter. 

Code it: You’ll submit several codes for this visit: 

• 340 (Multiple sclerosis) 
• 596.54 (Neurogenic bladder NOS) 
• V58.83 (Encounter for therapeutic drug monitoring) 
• V58.69 (Long-term [current] use of other medications) 
• V53.6 (Fitting and adjustment of urinary devices). 

Note: Although your patient is experiencing gait problems, you shouldn’t include 781.2 because this is an integral symptom of her multiple sclerosis.

“It is pertinent to separately report an associated diagnosis such as neurogenic bladder when your encounter involves addressing that issue, whereas symptoms normally associated with multiple sclerosis that are not being separately addressed need not be separately reported,” Przybylski says.