Pain Management Coding Alert

Here’s why you can’t always rely on nerve-specific ICD-10s.

Choosing a diagnosis code for a patient with a malignant cranial nerve neoplasm can be … well, nerve-wracking.

Why? Rules governing ICD-10 coding for this condition vary. There isn’t a single rule to follow for selecting malignant cranial neoplasm diagnoses. Further there are 12 cranial nerves, and there isn’t a corresponding code for each nerve — or a code encompassing all of them.

When you submit claims for malignant neoplasms in the cranial nerve(s), you can navigate to the right code by adopting the following 3 steps:

1. Identify which cranial nerve is involved.
2. Look if there is a dedicated code for the cranial nerve involved.
3. Check if you can be specific for right or left side involvement.

Step 1: Identify Cranial Nerve

When your physician documents the diagnosis of neoplasm in a cranial nerve, you should read the clinical record in detail and try to find out which cranial nerve was involved. Your physician may document the involved cranial nerve in either number or nomenclature. Refer to Table 1 below for details of name and number of cranial nerves.

Step 2: Check for Specific ICD-10 Code

ICD-10 has specific codes for neoplasms only in the cranial nerves I, II, and VIII, i.e. the olfactory, optic, and acoustic cranial nerves. The three-code series for these cranial nerves are: C72.2 (Malignant neoplasm of olfactory nerve), C72.3 (Malignant neoplasm of optic nerve), and C72.4 (Malignant neoplasm of acoustic nerve).

Find the fifth character: For malignant neoplasms in the olfactory, optic, and acoustic cranial nerves, you should describe the fifth character depending upon the laterality of the neoplasm. Table 2 lists the codes for the right and left sided involvement of these cranial nerves. In addition, you have specific codes which you can submit when your physician does not specify the laterality of the neoplasm.

“Malignant neoplasms of cranial nerves are quite uncommon. Consequently, there was likely no incentive to develop specific codes for a malignant neoplasm of each cranial nerve,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.

Step 3: Select Dx for Other Cranial Nerves

Your claims are not limited to only olfactory, optic, and acoustic cranial nerves. When your physician documents neoplasm in a cranial nerve other than these three nerves, you can prepare a claim with code C72.59 (Malignant neoplasm of other cranial nerves).

Don’t have a name or number for cranial nerve?  When your physician des not document the name or number of the cranial nerve involved with the neoplasm, you submit ICD-10 code C72.50 (Malignant neoplasm of unspecified cranial nerve).

More: The National Cancer Institute has described the functions of the cranial nerves and provided examples of tumors that can arise in these nerves. You can read more at: https://training.seer.cancer.gov/brain/tumors/anatomy/nerves.html.