Pain Management Coding Alert

ICD-10 codes include 42 NIHSS-related codes.

ICD-10 2017’s arrival made coding for strokes a little more involved, and a lot more specific. The newest diagnosis code book provides coders with ICD-10 codes to report National Institutes of Health Stroke Scale (NIHSS) scores for patients who took the assessment.

These 42 new codes will allow the physician to paint a more precise picture of the patient’s condition.

Read on for a primer on the NIHSS code set, and some expert input on how it will affect coding and patient care.

Now, There’s An ICD-10 for Each Scale Score

ICD-10 2017 features 43 NIHSS-specific codes in the R29.- (Other symptoms and signs involving the nervous and musculoskeletal systems) code set. The scale features a 42-point scoring system, and each score from 0 to 42 has its own code.

The scale score codes are R29.700 (NIHSS score 0) through R29.742 (NIHSS score 42). The higher the score, the more severe and devastating the stroke.

Impact: “This type of specificity can enhance the use of administrative databases to perform outcomes research,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. “The lack of clinical information in administrative databases has been the biggest obstacle to providing easily accessible clinicaland treatment information from a single searchable source.”

Physicians Use NIHSS to Guide Px Care

The provider performs the NIHSS to quantify the severity of ischemic strokes and make an objective assessment of the condition of the patient. The scale is a 15-item exam, vetted by the American Heart Association and the American Stroke Association, to assess the neurological status. The assessment includes level of consciousness, motor skills, facial palsy, limb ataxia, language, best gaze, and visual fields.