Orthopedic Coding Alert

Key: ICD-10 has different codes for the right and left limbs.

Meralgia paresthetica may be a diagnosis you encounter frequently in your orthopedic practice; under ICD-10, you'll need to look specifically for laterality details to accurately code this condition.

Code 355.1 (Meralgia paresthetica) in ICD-9 expands into three options in ICD-10, as of October 1, 2013:

• G57.10 (Meralgia paresthetica, unspecified lower limb)
• G57.11 (Meralgia paresthetica, right lower limb)
• G57.12 (Meralgia paresthetica, left lower limb)

Understand meralgia paresthetica

Meralgia paresthetica means the patient is experiencing numbness or pain in the outer thigh that is not caused by an injury to the thigh but an injury to the sensory nerve supplying that region. This nerve, called the lateral femoral cutaneous nerve, extends from the spinal column to the thigh. The cause of the numbness or pain is usually an entrapment or compression of the nerve. The pain may be acute and severe and may radiate distantly into the groin or ribs.

Determine Which Side is Affected

You'll choose these codes based on whether the complaints are in the right or left lower limb. You do have an unspecified option, but payers will want you to report to the highest specificity: either right or left. Make sure your orthopedic surgeon clearly specifies which side was affected.

Documentation: The provider most likely already documents the patient has meralgia paresthetica in the right or left lower limb, but in ICD-10-CM, you have a new way to reflect that.

Locate the Correct Code in the Index

When looking at the index, you will need to locate the meralgia codes by searching various terms. Here is how you will locate this code in the Alphabetic Index:

1. Meralgia paresthetica G57.1-

2. Mononeuritis G58.9

- lateral cutaneous nerve of thigh G57.1-

3. Mononeuropathy G58.9

- lower limb G57.9-

-- meralgia paresthetica G57.1-

4. Neuropathy, neuropathic G62.9

- entrapment G58.9

-- lateral cutaneous nerve of thigh G57.1-

5. Paresis -- see also Paralysis

- Bernhardt's G57.1-

6. Paresthesia -- see also Disturbance, sensation

- Bernhardt G57.1-

Coding tips: Underneath the G57 (Mononeuropathies of lower limb) category, you will find an Excludes 1 note that prevents you from reporting any of these codes with current traumatic nerve disorder codes. See nerve injury by body region. ICD-10 has a different representation for traumatic nerve injuries. "In ICD-10, traumatic nerve injuries such as contusion and lacerations are reported with codes beginning with letter 'S'," advises Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA."In ICD-10 coding, an acute injury to the lateral cutaneous sensory nerve involves selecting a 7 digit code from a series of 9 codes that begin with S74.2."