Neurology & Pain Management Coding Alert

Code neurological conditions based on diagnosis, not symptoms You might be an ace at coding complex degenerative conditions such as multiple sclerosis (340) or Parkinson's disease (332.0, Paralysis agitans), but don't let non-neurological conditions such as urinary tract infection (UTI) or sepsis trip you up. Knowing the subtleties of how these conditions sometimes relate to neurological conditions will help keep your next nonstandard claim clean. Diagnosis Know-How: Follow the Neuro-Septicemia Connection At first glance, urinary or sepsis problems might seem unrelated to neurological conditions, but a UTI can lead to neurological problems in elderly patients. "UTI means there are microorganisms in the urine (bacteria, fungus, etc.)," says Eugene C. Lai, MD, PhD, professor in the department of neurology at Baylor College of Medicine in Houston. "It may be asymptomatic, but in the elderly population, it -- and the antibiotics used to treat it -- can cause encephalopathy with altered mental status." Even more serious: When blood cultures grow out of infectious agents and spread throughout the body via the bloodstream, the physician might diagnose septicemia (038.9, Unspecified septicemia), bacteremia (790.7) or urosepsis (599.0, Urinary tract infection, site not specified, or 995.91, Sepsis). These are more serious medical conditions that require IV antibiotic and hospitalization for patients of any age, Lai says. "The infection will frequently cause encephalopathy with altered mental status and will aggravate any neurological condition the patient already has," Lai adds. "This can cause weakness, confusion, agitation, somnolence and other problems." Expect Most Uro-Related Cases During Consults
Because sepsis and UTI aren't conditions a patient would initially see a neurologist about, your physician will most likely see these patients when he completes a consult for another physician. "We see it more often in hospital consultations when the patient is being treated for another condition but is experiencing symptoms such as delirium or altered mental status," Lai says. Your neurologist might also be called in to rule out seizure or other neurological-related conditions for a particular patient. When your neurologist sees the patient during an inpatient consult, report the encounter with the appropriate code from 99251-99255 (Inpatient consultation for a new or established patient ...). "If the patient is agitated or confused, we might prescribe medications to help," Lai says. "Otherwise we don't normally order medications for the patient but advise the other physician regarding appropriate treatment." "Any new illness will make a patient's chronic neurological illness seem to be worse," adds Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine. "The primary-care physician will address the medical issues, [...]