Neurology & Pain Management Coding Alert

Don't limit yourself to one ICD-9 code, because it could be the wrong one If you don't know what differentiates an acute condition from a chronic one, or how many diagnosis codes you can report, you could find yourself assigning the wrong code. Before jumping to conclusions, check out the following two frequently asked questions to get quick tips to help your ICD-9 coding. How Many Diagnosis Codes Are -Too Many-? Question 1: Our neurologist treated a patient with diabetes, but he was actually seeing the patient to treat a complication of the diabetes, diabetic neuropathy. During his evaluation, the physician also noted that the patient had joint inflammation. Should we report the neuropathy complication only, or several of the ICD-9 codes?

Answer 1: Normally, the primary diagnosis code that you list on your claim should represent the main reason for the encounter, or the condition with the highest risk of morbidity/mortality that the physician addresses during the visit. The situation changes, however, when you deal with a condition like diabetes.

According to Section 1.A.6 of the ICD-9-CM Official Guidelines for Coding and Reporting, -Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-9-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation.-

The Guidelines continue, explaining that you may report more than one code from category 250 to -fully describe the patient's complete diabetic condition- if the patient has -more than one manifestation of diabetes.- 

Therefore, you should first report 250.6x (Diabetes with neurological manifestations) on the claim. Remember to add a fifth digit to reflect the type of diabetes the patient has.

Your secondary code should represent the specific neurological manifestation. In most cases, you will report 357.2 (Polyneuropathy in diabetes).Because the neurologist documented that the patient also has joint inflammation, you should report the appropriate code describing that condition (716.9x, Arthropathy, unspecified).

Although the insurer's computer will scan only the first, main diagnosis code that you list, you should list all of the codes that apply. That way, if the payer challenges a claim, you can help your appeal by having already sent the insurer all the patient's applicable diagnoses on record. Do Chronic Conditions Increase E/M Level? Question 2: The 1997 audit guidelines state that I can reach an extended history by updating the status of at least three chronic or inactive conditions. Our physician likes to refer to this information in both the history of present illness (HPI) section of the note as well as the assessment section of the note. Is this a good idea?

Answer 2: Although some physicians reference the illnesses in the assessment section of the [...]