Neurology & Pain Management Coding Alert

Remember, there are several types of hydrocephalus.

Neurologists who see patients with hydrocephalus need to make sure that their coders get their ICD-10 codes correct; if coders stumble at this step, the practice is at risk of losing deserved reimbursement for services.

Check out this expert Q&A on the basics of hydrocephalus coding, and your claims for patients with the condition will sail through the payer’s checkpoints.

Q: What is hydrocephalus?

A: Hydrocephalus is a condition caused by disturbance of formation, flow, or absorption of cerebrospinal fluid (CSF). This leads to buildup of fluid in the central nervous system (CNS), which can cause hydrocephalus.

“This can cause somnolence and brain injury from increased intracranial pressure,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Q: What are some of the types of hydrocephalus? 

A: Hydrocephalus may be either communicating or non-communicating. Communicating hydrocephalus occurs when the CSF is able to flow from ventricle to ventricle and circulate in its normal manner. Non-communicating hydrocephalus is caused by an obstruction within the ventricular system.

The ICD-9 and the corresponding ICD-10 codes for these conditions are listed below:

Congenital hydrocephalus: In ICD-9, you reported code 742.3 (Congenital hydrocephalus) for congenital hydrocephalus. When reporting the same in ICD-10, you need to make sure that your neurologist documents the underlying congenital lesion that leads to the congenital hydrocephalus. A common cause of the congenital hydrocephalus is an obstruction of the aqueduct or foramina through which the cerebrospinal fluid drains. There can be other reasons, too.

“Aqueductal stenosis is a common cause of congenital hydrocephalus, preventing CSF made in the lateral ventricles from traveling between the third and fourth ventricles,” Przybylski says. “This prevents the natural flow of CSF, leading to obstructive hydrocephalus.”

Bear in mind that the ICD-9 code 742.3 actually expands to three codes in ICD-10. Below are the codes in ICD-10 that you may appropriately select, depending upon the site of the obstruction, when reporting congenital hydrocephalus:

• Q03.0, Malformations of aqueduct of Sylvius
• Q03.1, Atresia of foramina of Magendie and Luschka
• Q03.8, Other congenital hydrocephalus.

Q: What procedures do neurologists perform for hydrocephalus patients?

A: The neurologist might perform a diagnostic or therapeutic spinal puncture, depending on the patient’s condition. You’ll choose 62270 (Spinal puncture, lumbar, diagnostic) for diagnostic spinal punctures, and 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]) for therapeutic punctures.

While the reasons for choosing a diagnostic spinal puncture are fairly straightforward, coding gets a little trickier for therapeutic encounters. A neurologist might perform a 62272 service for a hydrocephalus patient with a tumor, bleeding, or some other symptom associated with CSF buildup. 

Example: An established patient with communicating hydrocephalus reports to the neurologist complaining of short-term memory difficulties and trouble controlling his urination. After a separately identifiable and significant level-four E/M service, the neurologist decides that the patient has a CSF buildup in his brain, so she performs a therapeutic spinal puncture with catheter.

For this claim, you’d report:

• 62272 for the CSF drainage
• 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity…) for the E/M service
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to 99214 to show that you are coding for two separately identifiable services
• ICD-10 codes R41.3 (Other amnesia), R39.81 (Functional urinary incontinence) and G91.0 (Communicating hydrocephalus) to 62272 and 99214 to represent the patient’s conditions.