Psychiatry Coding & Reimbursement Alert
Think Alice in Wonderland Syndrome Doesn't Exist? Think Again
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Question: Our psychiatrist recently made a diagnosis of Alice in Wonderland Syndrome. I have never heard of this condition before. What code should I assign for this diagnosis?
Answer: Though it may appear to be absurd, there definitely is a condition referred to as "Alice in Wonderland syndrome (AIWS)." But while the ICD-9 code set does not contain a specific code for Alice in Wonderland Syndrome, the index to diseases in the ICD-9 manual does list "Alice in Wonderland syndrome" and directs you to use 293.89 (Other specified transient mental disorders due to conditions classified elsewhere; other). The manual also directs you to first code the associated physical or neurological conditions before the manifestation diagnosis code (i.e., 293.89 should be the second diagnosis you report).
Coding this condition also offers a good lesson: Certain conditions have both an underlying cause and multiple body system manifestations, and sorting out the primary diagnosis can be tricky. For such conditions, the ICD-9-CM has a specific way you should report the codes. Wherever such a combination exists, you should find a "use additional code" note with the cause or origin code (also known as the etiology), and a "code first" note at the manifestation code. These instructional notes tell you the proper order of the codes — etiology followed by manifestation.
What to report: In the case of AIWS, you might use 346.0x (Migraine with aura), 345.4x (Localization-related [focal][partial] epilepsy...) for temporal lobe epilepsy, or 075 (Infectious mononucleosis).
The code descriptor indicates that it is a manifestation code. You can never list "in diseases classified elsewhere" codes as first listed or principal diagnosis codes. You must use them after an underlying condition code.
AIWS includes a number of symptoms, such as severe migraines with aura (the same kind Lewis Carroll, Alice’s creator, is believed to have had), an altered body image (where the sizes of body parts such as head or hands are perceived incorrectly), and altered visual perception (where the sizes of external objects are perceived incorrectly).
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