Eli's Rehab Report

Answer: The most commonly used code for greater occipital neuralgia is 729.2 (neuralgia, neuritis, and radiculitis, unspecified). Occipital neuralgia is more of a symptom than a diagnosis, however, and usually occurs with an underlying condition. If so, code the underlying condition or a more definitive diagnosis if it is known. For example, occipital neuralgia often occurs with tendinitis, which for an unspecified site would be coded 726.90 (enthesopathy of unspecified site).

Both codes could be reported together for acute injuries. For example, if a patient is suffering from acute neck sprain (847.0) and occipital neuralgia, you could use 847.0 as the primary diagnosis, with 729.2 for the secondary diagnosis.

Because 729.2 is an unspecified code, you may want to confirm the diagnosis with the physician before billing it. As you probably noticed when searching the ICD-9 directory for occipital neuralgia, the instructional note of see also disorder, nerve appears often. The subterm occipital would not be found under this term, but under the subterm nervous system NEC is code 337.9 (unspecified disorder of autonomic nervous system). When comparing the two codes to see which is more specific to the diagnosis, 729.2 represents disorders of soft tissues and 337.9 refers to disorders of the autonomic nervous system. You should ask the physician which code best represents the diagnosis.

You Be the Coder was answered by Laurie Castillo, MA, CPC, president of Physician Coding and Compliance Consulting in Manassas, Va.