Neurosurgery Coding Alert

Question: Which diagnosis code should we report when a traumatic brain injury causes cognitive deficits? We can't find anything in the ICD-9 manual that addresses this.

Alaska Subscriber

Answer: Most coders report 294.9 (Unspecified persistent mental disorders due to conditions classified elsewhere) for this diagnosis, although they complain that its nonspecific nature can invite denials.

What it is: -Cognitive deficit- means the patient has difficulties in reasoning, judgment, intuition and memory, and lack of awareness and insight, whereas one definition for -cognitive impairment- is deficiency in ability to think, perceive, reason or remember resulting in loss of ability to attend to one's daily living needs.

Best bet: You should have your neurosurgeons clearly document what the patient has specific problems performing -- such as memory or lack of insight.

Option 1: If the neurosurgeon documents a specific problem due to brain damage, you may be able to classify the condition using a code from the 310.1-310.9 range. Even though these codes are in the mental disorders section, the subsection 310.x is clearly for nonpsychotic mental disorders due to brain damage.

Option 2: Others opt to use the associated dementia code (294.8), thinking that their documentation supports a more specified diagnosis than the -unspecified- for 294.9. On the other hand, these codes do fall under the section of persistent mental disorders due to conditions classified elsewhere, and in most cases this qualifies as coding -close- rather than coding the patient's actual condition. Without additional information, rather than coding close, you should choose the nonspecific code.

Keep in mind: This year, you have a new ICD-9 code (331.83, Mild cognitive impairment). However, this won't be a solution for the TBI cognitive deficit patients because the exclusions include cerebral degeneration (331.0-331.9), change in mental status (780.97), cognitive deficits following (late effects of) cerebral hemorrhage or infarction (438.0), cognitive impairment due to intracranial or head injury (850-854, 959.01), cognitive impairment due to late effect of intracranial injury (907.0), dementia (290.0-290.43, 294.8), mild memory disturbance (310.8), neurologic neglect syndrome (781.8), and nonpsychotic personality change (310.1). Answers to You Be the Coder and Reader Questions were reviewed by Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, N.J.