Neurosurgery Coding Alert

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You-ll no longer have to struggle with how to report significant pain for postoperative patients after the next round of ICD-9 changes takes effect Oct. 1. We-ve got a sneak peek at several diagnosis codes you-ll want to add to your superbill this fall.

Add Specificity With New Pain Codes

The newest ICD-9 revisions will allow you to more accurately describe a patient's type of significant pain. ICD-9 2007 offers a new series of 11 pain codes (338.0-338.4) that will be useful, especially for postoperative pain management.

The ability to code for acute or chronic postoperative pain will be good for several different purposes, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies in Powder Springs, Ga. For example, you can use these codes to justify a pain management consultation, admitting a patient postoperatively, or prolonging the patient's hospital stay:

- 338.0--Central pain syndrome
- 338.11--Acute pain due to trauma
- 338.12--Acute post-thoracotomy pain
- 338.18--Other acute postoperative pain
- 338.19--Other acute pain
- 338.21--Chronic pain due to trauma
- 338.22--Chronic post-thoracotomy pain
- 338.28--Other chronic postoperative pain
- 338.29--Other chronic pain
- 338.3--Neoplasm-related pain (acute) (chronic)
- 338.4--Chronic pain syndrome.

Benefit: Until the introduction of the new pain section, you-ve never had a way to describe -significant- pain like -acute pain due to trauma,- says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, coding manager for the University of Washington's physician group in Seattle. The new codes also represent pain that is outside what you-d expect or pain that requires extra treatment such as pain service visits (for example, 99201-99215, Office or other outpatient visit for the evaluation and management of a patient ...), Bucknam says.

Another option: If you-ve ever wondered which pain code you should report when the surgeon documents -generalized pain,- you now have an answer--780.96--although some coders believe that neurosurgeons normally see more precisely defined pain syndromes.

Update the Spine Section of Your Superbill

You-ll also discover several new spine coding diagnoses that your neurosurgeon can apply. Any of the codes with the prefix -myelo- will potentially be useful to neurosurgeons who deal with spinal issues. For example, your physician might use the new code for myelophthisis (284.2), which is wasting or atrophy of the spinal cord, sometimes as a secondary code, says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting & Coding Education LLC in Boardman, Ohio.

In addition, the following new ICD-9 codes will help spinal coders better pinpoint their patients- conditions:

- 341.20--Acute (transverse) myelitis NOS
- 341.21--Acute (transverse) myelitis in conditions classified elsewhere
- 341.22--Idiopathic transverse myelitis.

Look to -V- Codes for Dressing, Suture Visits

The ICD-9 guidebook will also unveil several new -V- codes to help supplement your primary diagnoses. The following codes are more specific aftercare codes you can use in place of V45.89 (Other postprocedural status):

- V58.30--Encounter for change or removal of nonsurgical wound dressing
- V58.31--Encounter for change or removal of surgical wound dressing
- V58.32--Encounter for removal of sutures.

Good news: -These diagnoses will be useful, although the procedures used with these codes may be included in the global surgery package and not payable,- Vogelberger says. -And that's OK because diagnosis codes are used to track patient care and provide medical necessity, not just to get a claim paid. These statistics are used for performance measurement to develop and shape our healthcare in the future.-

Beware: Make sure you don't report V58.3 after Oct. 1. The code will require a fourth digit once the new ICD-9 edits take effect.