Neurosurgery Coding Alert

But you should keep using 724.3 for spinal stenosis.

You're likely holding your breath in anticipation of the numerous changes expected with ICD-10. But don't overlook the coding changes in ICD-9 2011 that may affect how your neurosurgery practice uses cognition codes later this year. Stay ahead of the curve with this preview of new diagnosis codes.

724.03 Puts More Detail into EMG Testing

The ICD-9 2011 changes expand disease subcategories to provide more specific descriptions. New diagnosis codes that provide additional specificity can definitely be considered a positive for coders looking to provide more accurate claims.

One such case is with new code 724.03 (Spinal stenosis, lumbar region, with neurogenic claudication).

Neurosurgeons may perform diagnostic neuromuscular electrodiagnostic tests to determine whether the symptoms in a patient's extremities can be classified as neurogenic claudication due to stenosis. These may include: electromyography (EMG, 95860-95872, Needle electromyography) nerve conduction studies (NCS, 95900-95904, Nerve conduction, amplitude and latency/velocity ...) H-reflex tests (95934, H-reflex, amplitude and latency study ...).

Current way: ICD-9 currently does not include a specific diagnosis for neurogenic claudication. Until Oct. 1, you'll need to discuss the case with your physician to get a  better understanding of the condition so you can choose the most accurate diagnosis.

Neurosurgeons would most likely need to settle on reporting the patient's neurogenic claudication symptoms, which may include thigh or leg pain that would be described as an intermittent, cramping, and diffuse radiating pain with associated paresthesias.

This would cause burning, tingling, numbness, and potentially even muscle weakness. You'll therefore turn to 729.5 (Pain in limb), 782.0 (Disturbance of skin sensation), and 728.87 (Muscle weakness [generalized]) when billing for these services.

"You might also choose the more generic, unspecified ICD-9 code 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified)," says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver.

The problem: As is often the case, patient's symptoms can be due to many different conditions. During the evaluation, your physician may be able to differentiate between neurogenic claudication and vascular claudication as the source of the patient's complaints.

2011 solution: The new proposed ICD-9 code offers a more specific diagnosis that will allow differentiation between the two types of claudication. "There was no good way to code this oftendocumented diagnosis previously other than to capture only the lumbar spinal stenosis," says Laura Powers, MD, FAAN, of the American Academy of Neurology (AAN) in St. Paul, Minn.

Define Post-Traumatic Seizures with 780.33

Post-traumatic seizures are acute, symptomatic seizures following a head injury. In a Centers for Disease Control & Prevention release, the ICD-9-CM Coordination and Maintenance Committee explains that "a unique code for this type of seizure is important because these patients need to be followed for treatment as well as prognostic and epidemiologic considerations."

Result: The creation of 780.33 (Post traumatic seizures) hopes to further specify this type of seizure. "The advantage of this new code is that it captures the cause of the seizures as directly related to brain trauma," Powers says.

Current method: Your neurosurgeon may perform EEG testing (95812, Electroencephalogram [EEG] extended monitoring...) in order to differentiate types of seizures. In order to report the patient's symptoms coders often choose from the 780.3x (Convulsions) subcategory.

As with other kinds of seizures, post-traumatic seizures may not occur until weeks or months after the injury, when your neurologist may consider the seizure a late effect of the head injury.

"Based on the current ICD-9 guidelines, the documentation needs to indicate the causal relationship between the current condition/ symptom/sign and the underlying etiology," Hammer says. Remember: You will always need to rely on your neurosurgeon's documentation to determine whether to also code one of the late effects ICD-9 codes as a secondary diagnosis. Prepare for More Choices for Cognitive Testing The ICD-9 manual will also add a new Cognition category that will include the following seven codes:

• 799.50 -- Unspecified signs and symptoms involving cognition
• 799.51 -- Attention or concentration deficit
• 799.52 - Cognitive communication deficit
• 799.53 -- Visuospatial deficit
• 799.54 -- Psychomotor deficit
• 799.55 -- Frontal lobe and executive function deficit
• 799.59 -- Other signs and symptoms involving cognition.

The benefit: The fifth digit adds another level of specificity that may help in supporting payer authorization for the necessary diagnostic testing or treatment. "It potentially will help 'paint a clearer picture' of the patient's cognitive disabilities," Hammer says.

Bottom line: Prepare to check your payer's coverage policies to find out when these new codes will be required.