Psychiatry Coding & Reimbursement Alert
Think Alice in Wonderland Syndrome Doesn't Exist? Think Again
Question: Our psychiatrist recently made a diagnosis of Alice in Wonderland Syndrome. I have never heard of this condition before. What code should I assign for this diagnosis?
Answer: Though it may appear to be absurd, there definitely is a condition referred to as "Alice in Wonderland syndrome (AIWS)." But while the ICD-9 code set does not contain a specific code for Alice in Wonderland Syndrome, the index to diseases in the ICD-9 manual does list "Alice in Wonderland syndrome" and directs you to use 293.89 (Other specified transient mental disorders due to conditions classified elsewhere; other). The manual also directs you to first code the associated physical or neurological conditions before the manifestation diagnosis code (i.e., 293.89 should be the second diagnosis you report).
Coding this condition also offers a good lesson: Certain conditions have both an underlying cause and multiple body system manifestations, and sorting out the primary diagnosis can be tricky. For such conditions, the ICD-9-CM has a specific way you should report the codes. Wherever such a combination exists, you should find a "use additional code" note with the cause or origin code (also known as the etiology), and a "code first" note at the manifestation code. These instructional notes tell you the proper order of the codes — etiology followed by manifestation.
What to report: In the case of AIWS, you might use 346.0x (Migraine with aura), 345.4x (Localization-related [focal][partial] epilepsy...) for temporal lobe epilepsy, or 075 (Infectious mononucleosis).
The code descriptor indicates that it is a manifestation code. You can never list "in diseases classified elsewhere" codes as first listed or principal diagnosis codes. You must use them after an underlying condition code.
AIWS includes a number of symptoms, such as severe migraines with aura (the same kind Lewis Carroll, Alice’s creator, is believed to have had), an altered body image (where the sizes of body parts such as head or hands are perceived incorrectly), and altered visual perception (where the sizes of external objects are perceived incorrectly).
Cincinnati Subscriber
Psychiatry Coding & Reimbursement Alert
- CCI 19.0 Update:
Pay Attention to These Psychotherapy Crisis Code Bundles
Hint: Check modifier indicators to see if bundles can be overridden. The new CPT® codes [...] - 2013 Payment Update:
Fee Schedule Cut Reprieve Reduces Your Reimbursement Challenges--For Now
AMA is still pushing for a more permanent solution to the issue. If you were [...] - Audits:
Brace for Increased Lookback Period For Medicare Overpayments
The recently passed ‘fiscal cliff’ legislation has added two more years to your woes. If [...] - ICD-10 Update:
F84.0 Simplifies Autism Reporting in ICD-10
ICD-10 also reduces the list of exclusions for the condition.
If your [...] - You Be the Coder:
Base Psychotherapy Codes on Time, Not Place of Service
Question: The earlier code sets for psychotherapy depended on place of service (POS). But, I [...] - Reader Question:
Assign Diagnosis Code For Sundowning Based on Causative Condition
Question: Our psychiatrist recently assessed a 55-year-old male patient and noted sundowning in the patient [...] - Reader Question:
Reporting Hypnotherapy Using E/M or Psychotherapy Codes? Not so Fast
Question: One of our new clinical psychologists performs hypnotherapy sessions for his patients. I am [...] - Reader Question:
Think Alice in Wonderland Syndrome Doesn't Exist? Think Again
Question: Our psychiatrist recently made a diagnosis of Alice in Wonderland Syndrome. I have never [...] - Reader Question:
Double Ensure Patient Coverage Especially With New Insurance
Question: What caution and guidelines should I follow for a patient who has new coverage [...] - Reader Question:
Expect Penalties for Illegible Handwriting
Question: I have heard payers are cracking down on illegible provider documentation. My provider’s handwriting [...]
