Neurology & Pain Management Coding Alert

CTS, epilepsy prove medical necessity for EDX test suite.

When your provider performs electrodiagnostic (EDX) testing, you’ll need to submit an ICD-10 code to support medical necessity.

Problem: “The list of ICD-10 codes that are considered medically necessary to perform EDX testing is quite lengthy,” explains Carrie Winter, RHIA, health policy manager for American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM).

Solution: There are some diagnoses your provider will see more often than others to prove EDX tests are necessary. Remember, however, that while “some of these indications are more common than others, the reasons a patient might visit a physician for EDX testing are numerous,” Winter continues.

The AANEM published a 28-page list of EDX-approved ICD-10 codes on its website. Check out this sampling of ICD-10 codes you might see on an EDX claim:

• E10.41 — Type 1 diabetes mellitus with diabetic mononeuropathy
• E10.42 — Type 1 diabetes mellitus with diabetic polyneuropathy
• E11.41 — Type 2 diabetes mellitus with diabetic mononeuropathy
• E11.42 — Type 2 diabetes mellitus with diabetic polyneuropathy
• F45.42 — Pain disorder with related psychological factors
• G20 — Parkinson’s disease
• G35 — Multiple sclerosis
• G62.0 — Drug-induced polyneuropathy
• G90.511 — Complex regional pain syndrome I of right upper limb
• G90.512 — Complex regional pain syndrome I of left upper limb
• M21.371 — Foot drop, right foot
• M21.372 — Foot drop, left foot
• M48.01        — Spinal stenosis, occipito-atlanto-axial region
• M79.7 — Fibromyalgia
• Q05.0 — Cervical spina bifida with hydrocephalus
• Q05.1 — Thoracic spina bifida with hydrocephalus
• Q05.2 — Lumbar spina bifida with hydrocephalus
• S14.3 — Injury of brachial plexus.

Also: You should always check the patient’s applicable insurance coverage policy for covered EDX testing diagnoses.