Diseases of the Nervous System, Diseases of the Eye and Adnexa, and Diseases of the Ear and Mastoid Process: (ICD-10-CM Chapter 6, Codes G00-G99, Chapter 7, Codes H00-H59, and Chapter 8, Codes H60-H95)



Diseases of the Nervous System, Diseases of the Eye and Adnexa, and Diseases of the Ear and Mastoid Process


(ICD-10-CM Chapter 6, Codes G00-G99, Chapter 7, Codes H00-H59, and Chapter 8, Codes H60-H95)


Learning Objectives



Abbreviations/Acronyms


CNS central nervous system


CPAP continuous positive airway pressure


CSF cerebrospinal fluid


CVA cerebrovascular accident


DBS deep brain stimulation


EEG electroencephalogram


EMG electromyelogram


ICD-9-CM International Classification of Diseases, 9th Revision, Clinical Modification


ICD-10-CM International Classification of Diseases, 10th Revision, Clinical Modification


ICD-10-PCS International Classification of Diseases, 10th Revision, Procedure Coding System


IOL intraocular lens


IOP intraocular pressure


IV intravenous


LP lumbar puncture


MCI mild cognitive impairment


MRI magnetic resonance imaging


MS-DRG Medicare Severity diagnosis-related group


NPH normal pressure hydrocephalus


OM otitis media


OSA obstructive sleep apnea


PDT photodynamic therapy


SIRS systemic inflammatory response syndrome


SOM serous otitis media


SZ seizure


TIA transient ischemic attack


VPS ventriculoperitoneal shunt


VNS vagal nerve stimulator


ICD-10-CM Official Guidelines for Coding and Reporting


Please refer to the companion Evolve website for the most current guidelines.



6. Chapter 6: Diseases of Nervous System and Sense Organs (G00-G99)


a. Dominant/nondominant side
Codes from category G81, Hemiplegia and hemiparesis, and subcategories, G83.1, Monoplegia of lower limb, G83.2, Monoplegia of upper limb, and G83.3, Monoplegia, unspecified, identify whether the dominant or nondominant side is affected. Should the affected side be documented, but not specified as dominant or nondominant, and the classification system does not indicate a default, code selection is as follows:


• For ambidextrous patients, the default should be dominant.


• If the left side is affected, the default is non-dominant.


• If the right side is affected, the default is dominant.



Example


Patient is seen at physician’s office following discharge from the hospital following a CVA. Patient has hemiparesis of the right side, G81.91.


b. Pain—Category G89


1) General coding information
Codes in category G89, Pain, not elsewhere classified, may be used in conjunction with codes from other categories and chapters to provide more detail about acute or chronic pain and neoplasm-related pain, unless otherwise indicated below.
If the pain is not specified as acute or chronic, post-thoracotomy, postprocedural, or neoplasm-related, do not assign codes from category G89.
A code from category G89 should not be assigned if the underlying (definitive) diagnosis is known, unless the reason for the encounter is pain control/ management and not management of the underlying condition.
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 G89 should be assigned.



Example


The patient is admitted with acute chest pain due to pneumonia, J18.9. Only the code for pneumonia would be assigned.



Example


The patient is admitted for acute pain control after failing off a ladder and suffering two broken ribs on the right side. The patient was admitted for pain control, G89.11, S22.41xA, W11.xxxA.



Example


Patient with acute back pain secondary to an acute vertebral fracture of the C3 vertebra is admitted for a kyphoplasty. Patient fell while walking the dog, S12.201A, W18.39xA, 0PU33JZ, Y93.k1.


(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.



Example


Patient is admitted to the hospital with acute testicular pain. The patient had a vasectomy yesterday, and the physician documents postprocedural pain, G89.18, N50.8


• 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.



Example


Patient has acute pain secondary to lumbar spinal stenosis. She is admitted for insertion of a neurostimulator for pain control. The generator is inserted into the chest pocket, and the leads are inserted into the spinal canal via open approach, M54.5, M48.06, OJH60MZ, 00HU0MZ.


(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.



Example


Patient is admitted with acute back pain after being rear-ended by a vehicle while driving her children to school, M54.9, G89.11, V43.52xA.


(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.



Example


Patient presents to the ER with acute chest pain secondary to being kicked in the chest by a horse, R07.9, G89.11, W55.12xA.


2) Pain due to devices, implants and grafts
See Section I.C.19. Pain due to medical devices


3) Postoperative Pain
The provider’s documentation should be used to guide the coding of postoperative pain, as well as Section III. Reporting Additional Diagnoses and Section IV. Diagnostic Coding and Reporting in the Outpatient Setting.
The default for post-thoracotomy and other postoperative pain not specified as acute or chronic is the code for the acute form.
Routine or expected postoperative pain immediately after surgery should not be coded.



Example


Patient is seen in physician’s office after having a lesion removed from the lung. Patient presents complaining of chest pain. The physician’s diagnosis is post-thoracotomy pain, G89.12, R07.9.


(a) Postoperative pain not associated with specific postoperative complication
Postoperative pain not associated with a specific postoperative complication is assigned to the appropriate postoperative pain code in category G89.


(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).




Example


Patient is 1 month status post TURP. Patient presents to physician’s office with acute abdominal pain. After examination and assessment the physician documents acute post–TURP pain, G89.18, R10.9.


4) Chronic pain
Chronic pain is classified to subcategory G89.2. There is no time frame defining when pain becomes chronic pain. The provider’s documentation should be used to guide use of these codes.



Example


Patient is 2 years status post lumbar laminectomy and is being seen again for chronic low back pain, G89.28, M54.5.


5) Neoplasm Related Pain
Code G89.3 is assigned to pain documented as being related, associated or due to cancer, primary or secondary malignancy, or tumor. This code is assigned regardless of whether the pain is acute or chronic.
This code may be assigned as the principal or first-listed code when the stated reason for the admission/encounter is documented as pain control/pain management. The underlying neoplasm should be reported as an additional diagnosis.
When the reason for the admission/encounter is management of the neoplasm and the pain associated with the neoplasm is also documented, code G89.3 may be assigned as an additional diagnosis. It is not necessary to assign an additional code for the site of the pain.
See Section I.C.2 for instructions on the sequencing of neoplasms for all other stated reasons for the admission/encounter (except for pain control/pain management).



Example


Patient is admitted for pain control due to metastatic bone cancer. Patient has a past history of breast cancer treated with surgical removal, G89.3, C79.51, Z85.3.



Example


Patient was admitted for back pain due to vertebral metastasis. An MRI indicates that the disease has progressed. Patient has a history of prostate cancer with surgical removal, C79.51, G89.3, Z85.46. Patient’s bone mets treated with external beam radiation via the linear accelerator using electrons, DPOC3ZZ.


6) Chronic pain syndrome
Central pain syndrome (G89.0) and chronic pain syndrome (G89.4) are different than the term “chronic pain,” and therefore codes should only be used when the provider has specifically documented this condition.
See Section I.C.5. Pain disorders related to psychological factors


7. Chapter 7: Diseases of the Eye and Adnexa (H00-H59)


a. Glaucoma


1) Assigning Glaucoma Codes
Assign as many codes from category H40, Glaucoma, as needed to identify the type of glaucoma, the affected eye, and the glaucoma stage.


2) Bilateral glaucoma with same type and stage
When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and there is a code for bilateral glaucoma, report only the code for the type of glaucoma, bilateral, with the seventh character for the stage.
When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and the classification does not provide a code for bilateral glaucoma (i.e. subcategories H40.10, H40.11 and H40.20) report only one code for the type of glaucoma with the appropriate seventh character for the stage.


3) Bilateral glaucoma stage with different types or stages
When a patient has bilateral glaucoma and each eye is documented as having a different type or stage, and the classification distinguishes laterality, assign the appropriate code for each eye rather than the code for bilateral glaucoma.
When a patient has bilateral glaucoma and each eye is documented as having a different type, and the classification does not distinguish laterality (i.e. subcategories H40.10, H40.11 and H40.20), assign one code for each type of glaucoma with the appropriate seventh character for the stage.
When a patient has bilateral glaucoma and each eye is documented as having the same type, but different stage, and the classification does not distinguish laterality (i.e. subcategories H40.10, H40.11 and H40.20), assign a code for the type of glaucoma for each eye with the seventh character for the specific glaucoma stage documented for each eye.


4) Patient admitted with glaucoma and stage evolves during the admission
If a patient is admitted with glaucoma and the stage progresses during the admission, assign the code for highest stage documented.


5) Indeterminate stage glaucoma
Assignment of the seventh character “4” for “indeterminate stage” should be based on the clinical documentation. The seventh character “4” is used for glaucomas whose stage cannot be clinically determined. This seventh character should not be confused with the seventh character “0”, unspecified, which should be assigned when there is no documentation regarding the stage of the glaucoma.



Example


Patient presents to ophthalmologist’s office and is diagnosed with bilateral chronic angle closure glaucoma. Both eyes are mild stage, H40.2231.



Example


Patient presets to ophthalmologist’s office with bilateral acute angle closure glaucoma, right eye with moderate stage and left eye with severe, H40.2112, H40.2123.



Example


Glaucoma suspect in both eyes, H40.003.


8. Chapter 8: Diseases of Ear and Mastoid Process (H60-H95)
Reserved for future guideline expansion


Apply General Coding Guidelines as found in Chapter 5 and the Procedural Coding Guidelines as found in Chapters 6 and 7.


Anatomy and Physiology


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.




Central Nervous System


Different areas of the brain are in control of different functions of the body (Figure 14-3). For example, the cerebral cortex controls thought, language, and reasoning; the brain stem is in control of breathing and blood pressure; and the hippocampus is in control of memory and learning. The spinal cord serves as a pathway for information passing from the brain to the peripheral nervous system. Both the brain and the spinal cord are covered by bone—the brain by the skull, and the spinal cord by the vertebral column; both are covered by membranes called the meninges. The meninges (Figure 14-4) are made up of three layers: dura, arachnoid, and pia. In the spinal column, the dura is not attached to the vertebrae but is separated from them by the epidural space. The purpose of these membranes is to protect the brain and the spinal cord.




The spinal cord, which is located in the vertebral foramen, consists of 31 segments, each of which has a pair of spinal nerves that exit from the segment. The purpose of the spinal cord is to conduct nerve impulses and spinal reflexes.


Peripheral Nervous System


The peripheral nervous system connects the central nervous system to other parts of the body. It may be broken down into two parts: the somatic nervous system and the autonomic nervous system. The somatic nervous system sends sensory information (taste, hearing, smell, and vision) to the central nervous system (CNS) and motor nerve impulses to the skeletal muscles.


The autonomic nervous system has both sensory and motor functions that involve the CNS and the internal organs. Actions produced by this system, such as beating of the heart muscle, are for the most part involuntary.


Disease Conditions


Diseases of the Nervous System (G00-G99), Chapter 6 in the ICD-10-CM code book, Diseases of the Eye and Adnexa (H00-H59), Chapter 7 in the ICD-10-CM code book, and Diseases of the Ear and Mastoid Process (H60-95), Chapter 8 in the ICD-10-CM code book, are divided into the following categories:




























































































CATEGORY SECTION TITLE
G00-G09 Inflammatory diseases of the central nervous system
G10-G13 Systemic atrophies primarily affecting the central nervous system
G20-G26 Extrapyramidal and movement disorders
G30-G32 Other degenerative diseases of the nervous system
G35-G37 Demyelinating diseases of the central nervous system
G40-G47 Episodic and paroxysmal disorders
G50-G59 Nerve, nerve root, and plexus disorders
G60-G64 Polyneuropathies and other disorders of the peripheral nervous system
G70-G73 Diseases of myoneural junction and muscle
G80-G83 Cerebral palsy and other paralytic syndromes
G89-G99 Other disorders of the nervous system
H00-H05 Disorders of eyelid, lacrimal system, and orbit
H10-H11 Disorders of the conjunctiva
H15-H21 Disorders of sclera, cornea, iris, and ciliary body
H25-H28 Disorders of the lens
H30-H36 Disorders of the choroid and retina
H40-H42 Glaucoma
H43-H44 Disorders of the vitreous body and globe
H46-H47 Disorders of the optic nerve and visual pathways
H49-H52 Disorders of ocular muscles, binocular movement, accommodation, and refraction
H53-H54 Visual disturbances and blindness
H55-H57 Other disorders of eye and adnexa
H59 Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified
H60-H62 Diseases of external ear
H65-H75 Diseases of middle ear and mastoid
H80-H83 Diseases of the inner ear
H90-H94 Other disorders of ear
H95 Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified

Inflammatory Diseases of the Central Nervous System (G00-G09)


Meningitis is an infection or inflammation of the meninges. Meningitis is caused by a viral or bacterial organism and may be treated with antibiotics. Vaccines are available to prevent meningitis that is due to Streptococcus pneumoniae. It should be noted that often, coding of meningitis requires two codes, and in most cases, the Tabular List instructs to code the underlying condition first. For more information on coding guidelines for underlying conditions, refer to Chapter 5 in this text, General Coding Guidelines.



Example


The patient was treated for meningitis due to Lyme disease, A69.21.

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Related posts:

  1. Symptoms, Signs, and Abnormal Clinical and Laboratory Findings Not Elsewhere Classified, and Z Codes: (ICD-10-CM Chapters 18 and 21, Codes R00-R99, Z00-Z99)
  2. Diseases of the Respiratory System: (ICD-10-CM Chapter 10, Codes J00-J99)
  3. Certain Conditions Originating in the Perinatal Period, and Congenital Malformations, Deformations, and Chromosomal Abnormalities: (ICD-10-CM Chapter 16, Codes P00-P96 and Chapter 17, Codes Q00-Q99)
  4. The Health Record as the Foundation of Coding

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Jun 3, 2017 | Posted by in GENERAL SURGERY | Comments Off on Diseases of the Nervous System, Diseases of the Eye and Adnexa, and Diseases of the Ear and Mastoid Process: (ICD-10-CM Chapter 6, Codes G00-G99, Chapter 7, Codes H00-H59, and Chapter 8, Codes H60-H95)

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