Neurology ICD-10 CM Training. ICD-10-CM will be valid for dates of service on or after October 1, 2015 – Outpatient dates of service of October 1, 2015

Neurology

ICD-10 CM Training

• ICD-10-CM will be valid for dates of service on or after October 1, 2015– Outpatient dates of service of October 1, 2015 and

beyond. – Inpatient hospital service claims, is effective for dates of

discharge after September 30, 2015

ICD-10-CM Compliance Dates

• Covered Entities– Everyone covered by the Health Insurance Portability

Accountability Act (HIPPA)

• Non-Covered Entities– Worker’s Compensation– Auto Insurance– Non covered HIPAA entities are exempt but are

encouraged to adapt the new code set

Covered and Non-Covered Entities

• 21 Chapters• Alpha-numeric codes; not case-sensitive

– Codes begin with Alpha letter, A-Z, excluding U– Common errors

• I verses 1• O verses 0

• “X” Placeholder• 3 to 7 characters

– Decimal following 3rd character

ICD-10 Code Structure

• Placeholder “X”– Used for future expansion of a code– Fills in empty characters when a 6th and/or 7th character

apply– The placeholder may be used in different scenarios but

should never serve as the final character.

Example: W19.XXXA Unspecified fall, Initial Encounter


• 7th Character– Provides specified information regarding the clinical visit– Is required for certain categories and must be reported in

the seventh position– May be alpha or numeric– Has different meanings depending on the coding category


• Laterality– Some ICD-10-CM codes indicate laterality, specifying

whether the condition occurs on the left, right or is bilateral.

– If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

– If the side is not identified in the medical record, assign the code for the unspecified side.

OGCR section 1.B.13


• “Other” Codes– Codes titled “other” or “other specified” are for use when

the information in the medical record provides detail for which a specific code does not exist.

• “Unspecified” Codes– Codes titled “unspecified” are for use when the

information in the medical record is insufficient to assign a more specific code.

OGCR section 1.A.9.a.b


• Excludes Notes– Excludes1

• A type 1 Excludes note is a pure excludes note• It means “NOT CODED HERE”• The code excluded should never be used at the same time• When two conditions cannot occur together

– Excludes2• Represents “Not included here”• The condition excluded is not part of the condition represented

by the code• It is acceptable to use both the code and the excluded code

together, when appropriateOGCR section 1.A.12.a.b

ICD-10 Structure

• “Code First” and “Use Additional Code”– ICD-10 has a coding convention that requires the

underlying condition be sequenced first followed by the manifestation.

– These instructional notes indicate the proper sequencing order of the codes.

OGCR section 1.A.13

• The “-” indicates there are additional reporting options


Most Common Diagnosis Codes

Sleep apnea (adult) (pediatric)ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

327.20 G47.30 Sleep apnea, unspecified

Applicable to:• Sleep apnea NOS

• Apnea NOS (R06.81)

• Cheyne-Stokes breathing (R06.3)

• Pickwickian syndrome (E66.2)

• Sleep apnea of newborn (P28.3)

• nightmares (F51.5)• nonorganic sleep disorders

(F51.-)• sleep terrors (F51.4)• sleepwalking (F51.3)

There are more specific code choice selections below: SEE NEXT SLIDE

Sleep apneaICD-9 Code ICD-10 Code Description Excludes1 Excludes2

327.21 G47.31 Primary central sleep apnea • Apnea NOS (R06.81)

• Cheyne-Stokes breathing (R06.3)

• Pickwickian syndrome (E66.2)

• Sleep apnea of newborn (P28.3)

• nightmares (F51.5)

• nonorganic sleep disorders (F51.-)

• sleep terrors (F51.4)

• sleepwalking (F51.3)

327.22 G47.32 High altitude periodic breathing

327.23 G47.33 Obstructive sleep apnea (adult) (pediatric)

327.24 G47.34 Idiopathic sleep related nonobstructive alveolar hypoventilation

Applicable To:• Sleep related hypoxia

327.25 G47.35 Congenital central alveolar hypoventilation syndrome

327.26 G47.36 Sleep related hypoventilation in conditions classified elsewhere

327.27 G47.37 Central sleep apnea in conditions classified elsewhere

327.29 G47.39 Other sleep apnea

Code also any associated underlying condition

• Type– Congenital central alveolar hypoventilation syndrome– Idiopathic sleep related non-obstructive alveolar

hypoventilation– Obstructive– Primary central– Central sleep apnea associated with underlying condition– Primary sleep apnea of newborn

Sleep Apnea Documentation Tips

ConvulsionsICD-9 Code ICD-10 Code Description Excludes1 Excludes2

780.39 R56.9 Unspecified convulsions

Applicable To:• Convulsion disorder• Fit NOS• Recurrent convulsions• Seizure(s) (convulsive)

NOS

N/A • abnormal findings on antenatal screening of mother (O28.-)

• certain conditions originating in the perinatal period (P04-P96)

• signs and symptoms classified in the body system chapters

• signs and symptoms of breast (N63, N64.5)

There are additional code choice selections:

780.31 R56.00 Simple febrile convulsions

780.32 R56.01 Complex febrile convulsions

780.33 R56.1 Post traumatic seizures

• Type– Simple febrile– Complex febrile– Post-traumatic

Convulsions Documentation Tips

Multiple sclerosisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

340 G35 Multiple sclerosis

Applicable To:• Disseminated multiple

sclerosis• Generalized multiple

sclerosis• Multiple sclerosis NOS• Multiple sclerosis of brain

stem• Multiple sclerosis of cord

N/A• certain conditions originating in the

perinatal period (P04-P96)• certain infectious and parasitic diseases

(A00-B99)• complications of pregnancy, childbirth

and the puerperium (O00-O9A)• congenital malformations, deformations,

and chromosomal abnormalities (Q00-Q99)

• endocrine, nutritional and metabolic diseases (E00-E88)

• injury, poisoning and certain other consequences of external causes (S00-T88)

• neoplasms (C00-D49)• symptoms, signs and abnormal clinical

and laboratory findings, not elsewhere classified (R00-R94)

Parkinson's DiseaseICD-9 Code ICD-10 Code Description Excludes1 Excludes2

332.0 G20 Parkinson's disease• Hemiparkinsonism• Idiopathic

Parkinsonism or Parkinson's disease

• Paralysis agitans• Parkinsonism or

Parkinson's disease NOS

• Primary Parkinsonism or Parkinson's disease

• dementia with Parkinsonism (G31.83)


• certain infectious and parasitic diseases (A00-B99)

• complications of pregnancy, childbirth and the puerperium (O00-O9A)

• congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)



• neoplasms (C00-D49)• symptoms, signs and

abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

• Type– Idiopathic G20– Primary G20– Secondary G21.19

– Due to• Drugs G21.19• External agents G21.2• Treatment induced G21.19• Vascular G21.4

– With Dementia G31.83• Without behavioral disturbance [F02.80]• With behavioral disturbance [F02.81]

Parkinson’s Dx. Documentation Tips

Carpal tunnel syndrome, unspecified upper limbICD-9 Code ICD-10

CodeDescription Excludes1 Excludes2

354.0 G56.00 Carpal tunnel syndrome, unspecified upper limb

• current traumatic nerve disorder - see nerve injury by body region

N/A

There are more specific code choice selections below:

G56.01 Carpal tunnel syndrome, right upper limb

G56.02 Carpal tunnel syndrome, leftt upper limb

• Laterality– Right– Left– Bilateral

Carpal Tunnel Syndrome Documentation Tips

Anesthesia of skinICD-9 Code ICD-10 Code Description Excludes1 Excludes2

782.0 R20.0 Anesthesia of skin • dissociative anesthesia and sensory loss (F44.6)

• psychogenic disturbances (F45.8)

• symptoms relating to breast (N64.4-N64.5)782.0 R20.1 Hypoesthesia of skin • dissociative anesthesia and sensory

loss (F44.6)• psychogenic disturbances (F45.8)

782.0 R20.2 Paresthesia of skin

Applicable To:• Formication• Pins and needles• Tingling skin

• dissociative anesthesia and sensory loss (F44.6)

• psychogenic disturbances (F45.8)• acroparesthesia (I73.8)

782.0 R20.3 Hyperesthesia • dissociative anesthesia and sensory loss (F44.6)


782.0 R20.8 Other disturbances of skin sensation



782.0 R20.9 Unspecified disturbances of skin sensation



Localized-related (focal)(partial) epilepsy syndromes with complex partial seizures, with intractable epilepsy

ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

345.41 G40.211 Localization-related (focal)(partial) epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus

• conversion disorder with seizures (F44.5)

• convulsions NOS (R56.9)• hippocampal sclerosis

(G93.81)• mesial temporal sclerosis

(G93.81)• post traumatic seizures

(R56.1)• seizure (convulsive) NOS

(R56.9)• seizure of newborn (P90)• temporal sclerosis

(G93.81)• Todd's paralysis (G83.8)

N/A

345.41 G40.219 Localization-related (focal)(partial) epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus








N/A

Localization-related (focal)(partial) epilepsy and epileptic syndromes, with complex partial seizures, without mention of intractable epilepsyICD-9 Code ICD-10 Code Description Excludes1 Excludes2

345.40 G40.201 Localization-related (focal)(partial) epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus








N/A

345.40 G04.209 Localization-related (focal)(partial) epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus








N/A

Generalized convulsive epilepsy with intractable epilepsyICD-9 Code ICD-10 Code Description Excludes1 Excludes2

345.10 G40.311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus








N/A

345.10 G40.319 Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus








N/A

Generalized convulsive epilepsy without mention of intractable epilepsyICD-9 Code ICD-10 Code Description Excludes1 Excludes2

345.10 G40.301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus








N/A

345.10 G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus








N/A

• Status Epilepticus– With or without

• Intractability– Intractable– Not intractable

• Epilepsy Type– Absence syndrome– Due to external causes– Epileptic spasms– Generalized idiopathic– Juvenile myoclonic– Lennox-Gastaut– Partial idiopathic, localized onset

• Partial Seizure Type– With complex partial seizures– With simple partial seizures

• Note: The following terms are to be considered equivalent to intractable: pharmacoresistant (pharmacologically resistant), treatment resistant, refractory (medically) and poorly controlled.

Epilepsy Documentation Tips

Idiopathic Progressive PolyneuropathyICD-9 Code ICD-10 Code Description Excludes1 Excludes2

356.4 G60.3 Idiopathic progressive neuropathy

• neuralgia NOS (M79.2)

• neuritis NOS (M79.2)

• peripheral neuritis in pregnancy (O26.82-)

• radiculitis NOS (M54.10)

N/A

Thoracic or lumbosacral neuritis or radiculitis, unspecifiedICD-9 Code ICD-10 Code Description Excludes1 Excludes2

724.4 M54.14 Radiculopathy, thoracic region

• current injury - see injury of spine by body region

• discitis NOS (M46.4-)

• arthropathic psoriasis (L40.5-)• certain conditions originating in the perinatal

period (P04-P96)• certain infectious and parasitic diseases (A00-B99)• compartment syndrome (traumatic) (T79.A-)• complications of pregnancy, childbirth and the

puerperium (O00-O9A)• congenital malformations, deformations, and

chromosomal abnormalities (Q00-Q99)• endocrine, nutritional and metabolic diseases (E00-

E88)• injury, poisoning and certain other consequences

of external causes (S00-T88)• neoplasms (C00-D49)• symptoms, signs and abnormal clinical and

laboratory findings, not elsewhere classified (R00-R94)

There are more specific code choice selections below:

M54.15 Radiculopathy, thoracolumbar region

M54.16 Radiculopathy, lumbar region

M54.17 Radiculopathy, lumbosacral region

M51.14 Intervertebral disc disorders with radiculopathy, thoracic region

M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region

M51.16 Intervertebral disc disorders with radiculopathy, lumbar region

M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region

• Spinal Region– Thoracic– Thoracolumbar– Lumbar– Lumbosacral

Thoracic or Lumbosacral Neuritis or Radiculitis Documentation Tips

Respiratory Abnormality otherICD-9 Code ICD-10 Code Description Excludes1 Excludes2

786.09 R06.89 Other abnormalities of breathing

• acute respiratory distress syndrome (J80)

• respiratory arrest (R09.2)• respiratory arrest of newborn

(P28.81)• respiratory distress syndrome of

newborn (P22.-)• respiratory failure (J96.-)• respiratory failure of newborn

(P28.5)

N/A

There are additional code choice selections:R06.00 Dyspnea, unspecified

R06.01 Orthopnea

R06.02 Shortness of breath

R06.09 Other forms of dyspnea

R06.1 Stridor

R06.2 Wheezing

R06.3 Periodic breathing

R06.4 Hyperventilation

R06.5 Mouth breathing

R06.6 Hiccough

R06.7 Sneezing

R06.81 Apnea, not elsewhere classified

R06.82 Tachypnea, not elsewhere classified

R06.83 Snoring

• Use of symptom codes– Codes that describe symptoms and signs are acceptable for reporting purposes when a

related definitive diagnosis has not been established (confirmed) by the provider.

• Use of a symptom code with a definitive diagnosis code– Codes for signs and symptoms may be reported in addition to a related definitive

diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.

– Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

• Combination codes that include symptoms– ICD-10-CM contains a number of combination codes that identify both the definitive

diagnosis and common symptoms of that diagnosis. When using one of these combination codes, an additional code should not be assigned for the symptom.

Documentation Tips

Amyotrophic Lateral SclerosisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

335.20 G12.21 Amyotrophic lateral sclerosis







• neoplasms (C00-D49)• symptoms, signs and

abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

N/A

Lesion of Ulnar NerveICD-9 Code ICD-10 Code Description Excludes1 Excludes2

354.2 G56.20 Lesion of ulnar nerve, unspecified upper limb

• current traumatic nerve, nerve root and plexus disorders - see Injury, nerve by body region

• neuralgia NOS (M79.2)

• neuritis NOS (M79.2)

• peripheral neuritis in pregnancy (O26.82-)

• radiculitis NOS







• neoplasms (C00-D49)• symptoms, signs and abnormal

clinical and laboratory findings, not elsewhere classified (R00-R94)

There are additional code choices:

G56.21 Lesion of ulnar nerve, right upper limb

G56.22 Lesion of ulnar nerve, left upper limb

• Laterality– Left– Right– Bilateral

Lesion of Ulnar Nerve Documentation Tips

Essential and other specified forms of tremorICD-9 Code ICD-10 Code Description Excludes1 Excludes2

333.1 G25.0 Essential tremor

Applicable to:• Familial tremor

• tremor NOS (R25.1)

• Sleep related movement disorders (G47.6-)

333.1 G25.1 Drug-induced tremor

Applicable To:• Familial tremorUse additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

333.1 G25.2 Other specified forms of tremor

Applicable to:• Intention tremor

Syncope and collapseICD-9 Code ICD-10 Code Description Excludes1 Excludes2

780.2 R55 Syncope and collapse

Applicable To:• Blackout• Fainting• Vasovagal attack

• cardiogenic shock (R57.0)• carotid sinus syncope

(G90.01)• heat syncope (T67.1)• neurocirculatory asthenia

(F45.8)• neurogenic orthostatic

hypotension (G90.3)• orthostatic hypotension

(I95.1)• postprocedural shock

(T81.1-)• psychogenic syncope

(F48.8)• shock NOS (R57.9)• shock complicating or

following abortion or ectopic or molar pregnancy (O00-O07, O08.3)

• shock complicating or following labor and delivery (O75.1)

• Stokes-Adams attack (I45.9)• unconsciousness NOS

(R40.2-)

• abnormal findings on antenatal screening of mother (O28.-)


• signs and symptoms classified in the body system chapters

• signs and symptoms of breast (N63, N64.5)

• Type– Carotid sinus syncope– Heat syncope

• Initial encounter• Subsequent encounter• sequela

– Psychogenic syncope– Stokes-Adams syncope– Vasovagal syncope

Syncope Documentation Tips

All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.

• Site specificity• Document notation of qualifiers

– Exacerbation– Manifestations– Relapse– Status– Stages

• Indicate acute or chronic• Indicate underlying or external cause factors

– Medication– Smoke– Accidents– Mechanical failure

• Laterality– Bilateral– Right – Left

Documentation – Start Now

• Episode of Care for injuries, poisoning, external causes and other conditions– Initial Encounter

• Use while the patient is receiving active treatment of the condition– Active treatment includes surgical treatment, an emergency encounter, and

evaluation and treatment by a new physician

– Subsequent Encounter• Used on encounter after the patient has received active treatment of

the condition and is receiving routine care for the condition during the healing or recovery phase.

– Medication adjustments, aftercare, device adjustments, cast change

– Sequela• Used for complications or conditions that arise as a direct result of a

condition, late effect


• Combination codes that capture– Etiology and manifestation– Related conditions– Disease, injury or other medical condition and

complications– Disease or other medical conditions and common signs or

symptoms

• Add ICD-10 Codes to patient Problem List


UnderdosingUnderdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”).

Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.

Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known.

OGCR Section 1.C.19.e.5.c

Official Guidelines for Coding and Reporting

[email protected]

Centers for Disease Control and Prevention (ICD-10-CM)http://www.cdc.gov/nchs/icd/icd10cm.htm

Questions

mailto:[email protected]

http://www.cdc.gov/nchs/icd/icd10cm.htm

http://www.cdc.gov/nchs/icd/icd10cm.htm

Documents

Neurology ICD-10 CM Training. ICD-10-CM will be valid for dates of service on or after October 1, 2015 – Outpatient dates of service of October 1, 2015