1. Apply and assign the correct ICD-9-CM and ICD-10-CM codes in accordance with Official Guidelines for Coding and Reporting 2. Identify major differences between ICD-9-CM and ICD-10-CM related to the nervous system and sense organs 3. Identify pertinent anatomy and physiology of the nervous system and sense organs 4. Identify diseases of the nervous system and sense organs 5. Assign the correct V/Z codes and procedure codes related to the nervous system and sense organs 6. Identify common treatments, medications, laboratory values, and diagnostic tests 7. Explain the importance of documentation in relation to MS-DRGs for reimbursement Please refer to the companion Evolve website for the most current guidelines. 6. Chapter 6: Diseases of Nervous System and Sense Organs (320-389) (a) Category 338 Codes as Principal or First-Listed Diagnosis Category 338 codes are acceptable as principal diagnosis or the first-listed code: • When pain control or pain management is the reason for the admission/encounter (e.g., a patient with displaced intervertebral disc, nerve impingement and severe back pain presents for injection of steroid into the spinal canal). The underlying cause of the pain should be reported as an additional diagnosis, if known. • When an admission or encounter is for a procedure aimed at treating the underlying condition (e.g., spinal fusion, kyphoplasty), a code for the underlying condition (e.g., vertebral fracture, spinal stenosis) should be assigned as the principal diagnosis. No code from category 338 should be assigned. • When a patient is admitted for the insertion of a neurostimulator for pain control, assign the appropriate pain code as the principal or first-listed diagnosis. When an admission or encounter is for a procedure aimed at treating the underlying condition, and a neurostimulator is inserted for pain control during the same admission/encounter, a code for the underlying condition should be assigned as the principal diagnosis, and the appropriate pain code should be assigned as a secondary diagnosis. (b) Use of Category 338 Codes in Conjunction With Site Specific Pain Codes (i) Assigning Category 338 Codes and Site-Specific Pain Codes Codes from category 338 may be used in conjunction with codes that identify the site of pain (including codes from chapter 16) if the category 338 code provides additional information. For example, if the code describes the site of the pain, but does not fully describe whether the pain is acute or chronic, then both codes should be assigned. (ii) Sequencing of Category 338 Codes with Site-Specific Pain Codes The sequencing of category 338 codes with site-specific pain codes (including chapter 16 codes) is dependent on the circumstances of the encounter/admission as follows: • If the encounter is for pain control or pain management, assign the code from category 338 followed by the code identifying the specific site of pain (e.g., encounter for pain management for acute neck pain from trauma is assigned code 338.11, Acute pain due to trauma, followed by code 723.1, Cervicalgia, to identify the site of pain). • If the encounter is for any other reason except pain control or pain management, and a related definitive diagnosis has not been established (confirmed) by the provider, assign the code for the specific site of pain first, followed by the appropriate code from category 338. 2) Pain due to devices, implants and grafts Pain associated with devices, implants or grafts left in a surgical site (for example painful hip prosthesis) is assigned to the appropriate code(s) found in Chapter 17, Injury and Poisoning. Use additional code(s) from category 338 to identify acute or chronic pain due to presence of the device, implant or graft (338.18-338.19 or 338.28-338.29). Routine or expected postoperative pain immediately after surgery should not be coded. (a) Postoperative pain not associated with specific postoperative complication (b) Postoperative pain associated with specific postoperative complication Postoperative pain associated with a specific postoperative complication (such as painful wire sutures) is assigned to the appropriate code(s) found in Chapter 17, Injury and Poisoning. If appropriate, use additional code(s) from category 338 to identify acute or chronic pain (338.18 or 338.28). If pain control/management is the reason for the encounter, a code from category 338 should be assigned as the principal or first-listed diagnosis in accordance with Section I.C.6.a.1.a above. (c) Postoperative pain as principal or first-listed diagnosis (d) Postoperative pain as secondary diagnosis See Section IV.A.2 for information on sequencing of diagnoses for patients admitted for observation. Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 6. Please refer to the companion Evolve website for the most current guidelines. 6. Chapter 6: Diseases of Nervous System and Sense Organs (G00-G99) • For ambidextrous patients, the default should be dominant. • If the left side is affected, the default is non-dominant. (a) Category G89 Codes as Principal or First-Listed Diagnosis Category G89 codes are acceptable as principal diagnosis or the first-listed code: • When pain control or pain management is the reason for the admission/encounter (e.g., a patient with displaced intervertebral disc, nerve impingement and severe back pain presents for injection of steroid into the spinal canal). The underlying cause of the pain should be reported as an additional diagnosis, if known. • When a patient is admitted for the insertion of a neurostimulator for pain control, assign the appropriate pain code as the principal or first-listed diagnosis. When an admission or encounter is for a procedure aimed at treating the underlying condition and a neurostimulator is inserted for pain control during the same admission/encounter, a code for the underlying condition should be assigned as the principal diagnosis and the appropriate pain code should be assigned as a secondary diagnosis. (b) Use of Category G89 Codes in Conjunction with Site Specific Pain Codes (i) Assigning Category G89 and Site-Specific Pain Codes Codes from category G89 may be used in conjunction with codes that identify the site of pain (including codes from chapter 18) if the category G89 code provides additional information. For example, if the code describes the site of the pain, but does not fully describe whether the pain is acute or chronic, then both codes should be assigned. (ii) Sequencing of Category G89 Codes with Site-Specific Pain Codes The sequencing of category G89 codes with site-specific pain codes (including chapter 18 codes), is dependent on the circumstances of the encounter/admission as follows: • If the encounter is for pain control or pain management, assign the code from category G89 followed by the code identifying the specific site of pain (e.g., encounter for pain management for acute neck pain from trauma is assigned code G89.11, Acute pain due to trauma, followed by code M54.2, Cervicalgia, to identify the site of pain). • If the encounter is for any other reason except pain control or pain management, and a related definitive diagnosis has not been established (confirmed) by the provider, assign the code for the specific site of pain first, followed by the appropriate code from category G89. 2) Pain due to devices, implants and grafts See Section I.C.19. Pain due to medical devices Routine or expected postoperative pain immediately after surgery should not be coded. (a) Postoperative pain not associated with specific postoperative complication (b) Postoperative pain associated with specific postoperative complication Postoperative pain associated with a specific postoperative complication (such as painful wire sutures) is assigned to the appropriate code(s) found in Chapter 19, Injury, poisoning, and certain other consequences of external causes. If appropriate, use additional code(s) from category G89 to identify acute or chronic pain (G89.18 or G89.28). See Section I.C.5. Pain disorders related to psychological factors 7. Chapter 7: Diseases of the Eye and Adnexa (HOO-H59) 8. Chapter 8: Diseases of Ear and Mastoid Process (H60-H95) Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 7. • Codes for hemiplegia and monoplegia identify whether the dominant or nondominant side is affected. If the information is not available, the default is Dominant. The default for ambidextrous people is also Dominant. • There are currently no guidelines in ICD-10-CM for diseases of eye and adnexa and diseases of the ear and mastoid process. • Codes for TIA are now included in the nervous system chapter in ICD-10-CM. • Codes for migraine have been expanded to fifth and sixth characters to indicate whether the migraine is intractable and to reflect additional specificity. • Codes for secondary parkinsonism have been expanded at the fourth or fifth characters for more specificity. The nervous system is composed of specialized tissue that controls the actions and reactions of the body and the way it adjusts to changes that occur inside and outside the body. The nervous system is divided into two main systems: the central nervous system and the peripheral nervous system (Figures 14-1 and 14-2). The central nervous system and the peripheral nervous system are each further divided into two parts. The central nervous system is made up of the brain and the spinal cord, and the peripheral nervous system is made up of the somatic nervous system and the autonomic nervous system.
Diseases of the Nervous System and Sense Organs
(ICD-9-CM Chapter 6, Codes 320-389, and ICD-10-CM Chapter 6, Codes G00-G99, Chapter 7, Codes H00-H59, and Chapter 8, Codes H60-H95)
ICD-9-CM Official Guidelines for Coding and Reporting
ICD-10-CM Official Guidelines for Coding and Reporting
Guideline Differences between ICD-9-CM and ICD-10-CM
Major Differences between ICD-9-CM and ICD-10-CM
Anatomy and Physiology
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