Neurology & Pain Management Coding Alert

Report the myelopathy, ganglionitis, neuropathy, and unspecified neurological complications.

When you're faced with a neurological complication after an episode of Herpes zoster, you'll need to know how to report it once ICD-10 comes into effect Oct. 1, 2013. Take our advice below on pinning down the appropriate diagnosis for specific neurological complication associated with the Herpes zoster virus.

Review the basics: Herpes zoster, commonly known as shingles and also known as zona, is caused by varicella zoster virus (VZV), the same infection that causes chicken pox. "The estimated annual number of Herpes zoster cases in the United States is approximately 1 million," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co.

Coding for Herpes zoster without complications is simple as there is a single code. "Herpes zoster without complications is currently reported with 053.9 (Herpes zoster without mention of complications) which is cross walked over to B02.9 (Zoster without complications) for ICD-10" says Hammer.

The challenge: Reporting of complications other than meningitis needs a deeper knowledge of the possible complications. Code 053.1x for other nervous system complications in Herpes zoster, encompasses six codes in ICD-9 (053.10 to 053.19). These complications refer to manifestations other than meningitis associated with Herpes zoster.

Brush Up on Possible Complications

A common complication of Herpes zoster is postherpetic neuralgia (PHN), which is pain that persists for longer than one month following resolution of the rash. "The reported incidence of postherpetic neuralgia ranges from 8 to 70 percent and both the incidence and duration increases with advancing age," says Hammer. "If the pain management specialist notes a diagnosis of postherpetic neuralgia, you would search the alphabetic index in looking for the correct ICD-9 or ICD-10 code. For dates of service prior to Oct 1, 2013, you will report 053.19 (...other nervous system complications) but after the ICD-10 implementation date, you will bill B02.29 (Other postherpetic nervous system involvement)."

Hammer explains, "Both ICD-9 and ICD-10 include diagnosis codes for PHN of specific cranial nerves, including of the trigeminal nerve: 053.12 (Postherpetic trigeminal neuralgia) for ICD-9 and likewise B02.22 for ICD-10. Currently this diagnosis is coded as 053.11

(Geniculate herpes zoster); however, for ICD-10 it will be reported as B02.21 (Postherpetic geniculate ganglionitis)."

Chronic VZV Encephalitis, inflammation of the brain due to a viral infection, is a rare but deadly complication of Herpes zoster. "ICD-10 provides a specific diagnosis code for this complication, V02.0 (Zoster encephalitis), whereas ICD-9 does not list a specific code for encephalitis associated with Herpes zoster" says Hammer.

Another major complication associated with Herpes zoster is meningitis. Meningitis in Herpes zoster is reported with ICD-9 code 053.0 (Herpes zoster with meningitis). This corresponds to code B02.1 (Zoster meningitis) in ICD-10. There are many other neurological complications possible with Herpes zoster; these include polyneuropathy, myelitis, and radiculopathy.

In summary: In codes B02.29, B02.21, and B02.24, there is a change in the descriptor from 'Herpes zoster' in the ICD-9 to 'postherpetic' in the ICD-10 descriptors, which adds specificity. Complications like myelitis, geniculate ganglionitis, and other nervous system conditions develop after the rash of the herpetic infection. Hence, the ICD-10 descriptors are more precise.