Neurosurgery Coding Alert

Hint: ICD-10 adds new code G96.01 for spontaneous cranial CSF.

ICD-10-CM recently released its new set of codes for 2021, and you should start familiarizing themselves with the codes now, not later. As always, the ICD-10 2021 codes are official on October 1, 2020. So, you’ve got about two months to get used to all of the updates ICD-10 2021 will bring.

Check out the most impactful changes to ICD-10 for your neurosurgery practice.

Gain 3 Brand-New Ataxia Codes

You will see a few changes to the “G11 (Hereditary ataxia)” category. On October 1, ICD-10 will add these codes to the set:

• G11.10 (Early-onset cerebellar ataxia, unspecified)
• G11.11 (Friedreich ataxia)
• G11.19 (Other early-onset cerebellar ataxia)

Definition: According to ataxia.org, “ataxia is a degenerative disease of the nervous system. Many symptoms of ataxia mimic those of being drunk, such as slurred speech, stumbling, falling, and incoordination. These symptoms are caused by damage to the cerebellum, the part of the brain that is responsible for coordinating movement.”

Pinpoint New Dxs for Dravet Syndrome

Also, ICD-10 2021 will also add several codes to G40.- (Epilepsy and recurrent seizures) to represent some specific conditions. The latest diagnosis code book will feature the following new codes:

• G40.42 (Cyclin-Dependent Kinase-Like 5 Deficiency Disorder)
• G40.83- (Dravet syndrome)
• G40.833 (Dravet syndrome, intractable, with status epilepticus)
• G40.834 (Dravet syndrome, intractable, without status epilepticus)

Definition 1: “Cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD) is a developmental encephalopathy caused by pathogenic variants in the gene CDKL5. This unique disorder includes early infantile onset refractory epilepsy, hypotonia, developmental intellectual and motor disabilities, and cortical visual impairment,” according to the National Institutes of Health (NIH).

Definition 2: Dravet syndrome “is a rare, catastrophic, lifelong form of epilepsy that begins in the first year of life with frequent and/or prolonged seizures,” according to the Dravet Syndrome Foundation. Dravet syndrome was previously known as severe myoclonic epilepsy of infancy (SMEI).

Add Increased Specificity to CSF Leak Dxs

A comprehensive list of new codes added to category code G96- (Other disorders of central nervous system) is another area you need to keep an eye out for in your neurosurgery practice. With respect to cerebrospinal fluid (CSF) leaks, reporting using the current ICD-10-CM manual begins and ends at G96.0 (Cerebrospinal fluid leak). In 2021, you will report unspecified CSF leaks as G96.00 (Cerebrospinal fluid leak, unspecified). However, you’ll also have the option of reporting more specified forms of CSF leaks:

• G96.01 (Cranial cerebrospinal fluid leak, spontaneous)
• G96.02 (Spinal cerebrospinal fluid leak, spontaneous)
• G96.08 (Other cranial cerebrospinal fluid leak)
• G96.09 (Other spinal cerebrospinal fluid leak)

Note: Keep in mind that many new code additions also include parenthetical notes located in the tabular, such as “Use additional,” “Excludes,” and “Code also.” Category code G96 includes a few more crucial additions to the ICD-10-CM index that you need to be aware of. Specifically, these changes will impact your coding of conditions affecting the spinal meninges. First, you’ll find that code G96.19 (Other disorders of meninges, not elsewhere classified) will convert to G96.198 (same code descriptor). Next, you’ll now have the option of reporting the following code for documented perineural cysts:

• G96.191 (Perineural cyst)

Don’t miss: You’ll also see in the tabular that you should report G96.191 when the documentation includes any of the following:

• Cervical nerve root cyst
• Lumbar nerve root cyst
• Sacral nerve root cyst
• Tarlov cyst
• Thoracic nerve root cyst

Introduce Yourself to This Set of Intracranial Hypotension Codes

Next, get acquainted with the following set of codes specific to subcategory code G96.81- (Intracranial hypotension):

• G96.810 (Intracranial hypotension, unspecified)
• G96.811 (Intracranial hypotension, spontaneous)
• G96.819 (Other intracranial hypotension)

You’ll find an extensive list of “Code also” notes underneath subcategory code G96.81- to consider for any of the above three diagnoses. For instance, if intracranial hypotension is accompanied by a stroke or a cerebrospinal fluid leak from the spine, you’ll report the following respective codes as secondary diagnoses:

• I63.- (Stroke)
• G96.02 (Spinal cerebrospinal fluid leak, spontaneous) — also new in 2021.

And, you’ll also gain new intracranial hypotension codes G97.83 (Intracranial hypotension following lumbar cerebrospinal fluid shunting) and G97.84 (Intracranial hypotension following other procedure).

Headache NOS Gets Extra Character

There were also a couple of changes to how you’ll code for certain headaches on October 1. ICD-10 added R51.0 (Headache with orthostatic component, not elsewhere classified). You should also use this code to identify headache with positional component, not elsewhere classified.

Also, ICD-10 moved unspecified headaches to its own classification, R51.9 (Headache, unspecified).

In 2020, this code set consisted only of R51 (Headache). In 2021, you’ll use R51.9 to report headache NOS.