Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 9: Diseases of the Nervous System (G00–G99)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of diseases of the nervous system?

3. ICD-10-CM Chapter 6, Diseases of the Nervous System (G00–G99) Chapter 6 of ICD-10-CM includes the following blocks of codes: G00–G09 Inflammatory diseases of the central nervous system G10–G14 Systemic atrophies primarily affecting the central nervous system G20–G26 Extrapyramidal and movement disorders G30–G32 Other degenerative diseases of the nervous system

4. ICD-10-CM Chapter 6, Diseases of the Nervous System (G00–G99) G40–G47 Episodic and paroxysmal disorders G50–G59 Nerve, nerve root and plexus disorders G60–G65 Polyneuropathies and other disorders of the peripheral nervous system G70–G70 Diseases of myoneural junction and muscle G80–G83 Cerebral palsy and other paralytic syndromes G89–G99 Other disorders of the nervous system

5. ICD-10-CM Chapter 6, Diseases of the Nervous System (G00–G99) Includes diseases of the central and peripheral nervous system as well as epilepsy and recurrent seizures, migraine, other headache syndromes, and sleep disorders.

6. Instructional Notes for ICD-10-CM Chapter 6 Throughout the chapter are instructional notes: “use additional code to identify organism” “code first underlying diseases” “use additional code for adverse effect, if applicable, to identify drug” “code also any associated condition” Multiple coding is frequently required

7. Instructional Notes for ICD-10-CM Chapter 6 Code G89, Pain, not elsewhere classified, includes a note “code also related psychological factors affiliated with pain (F45.42) Excludes1 note here reminds coders what not to code with G89, for example, specifically generalized pain Excludes2 note remind coders what other pain codes can be assigned with G89, for example, a code for the site of the pain

8. Coding Guidelines for ICD-10-CM Chapter 6 The ICD-10-CM Official Guidelines for Coding and Reporting include chapter specific guidelines for diseases of the nervous system Specific guidelines address the coding of hemiplegia and hemiparesis and the coding of pain

9. Coding Guidelines for ICD-10-CM Chapter 6 Chapter specific guidelines appear in the textbook labeled as CG. Dominant or nondominantside Codes from category G81, hemiplegia and hemiparesis and subcategories G83.1-G83.3, identify whether the dominant or non-dominant side is affected. Should the affected side be documented, but not specified as dominant or non-dominant, and the classification 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

10. Coding Guidelines for ICD-10-CM Chapter 6 Chapter specific guidelines address the coding of Pain, category G89, with general instructions for the coding of pain Pain due to devices, implants, and grafts Postoperative pain Chronic pain Neoplasm related pain Chronic pain syndrome

11. Coding Diseases of the Nervous System Meningitis Inflammation of the meninges which cover the brain and the spinal cord Variety of microorganisms or virus can cause meningitis and are coded differently

12. Coding Diseases of the Nervous System Organic Sleep Disorders G47 with fourth and fifth digit codes classify various types of insomnia, hypersomnia, circadian rhythm sleep disorders, sleep apnea, narcolepsy and cataplexy, parasomnia, and sleep-related movement disorders

13. Coding Diseases of the Nervous System Other degenerative diseases of the nervous system Alzheimer’s Disease Early onset and late onset Use additional code to identify delirium, dementia with and without behavioral disturbance Pick’s Disease Dementia with Lewy bodies

14. Coding Diseases of the Nervous System Pain, Not Elsewhere Classified Unique codes for encounters for pain management Use additional code notes Excludes note included Central pain syndrome Acute pain and chronic pain Neoplasm-related pain

15. Coding Diseases of the Nervous System Sequencing of category G89 codes with site-specific pain codes depends on the circumstances of the admission or outpatient visit If the encounter is for pain control or pain management, the code from G89 is sequenced first, followed by the code for the specific site of the pain or the underlying cause of the pain, if known.

16. Coding Diseases of the Nervous System Sequencing of category G89 codes with site-specific pain codes depends on the circumstances of the admission or outpatient visit When admission or encounter is for a procedure aimed at treating the underlying condition, a code for the underlying condition should be assigned first. No code from G89 should be assigned

17. Coding Diseases of the Nervous System Sequencing of category G89 codes with site-specific pain codes depends on the circumstances of the admission or outpatient visit When an admission or encounter is for any other reason except pain control or pain management, and a related definitive diagnosis has not been established, a code for the specific site of the pain is listed first, followed by the appropriate code from category G89

18. Coding Diseases of the Nervous System Sequencing of category G89 codes with site-specific pain codes depends on the circumstances of the admission or outpatient visit Codes for postoperative or post-thoracotomy pain are classified to the subcategories of G89.1 or G89.2 depending on whether the pain is acute or chronic. Codes for postoperative pain may be first listed when the reason for the visit is documented as such Postoperative pain can be reported as secondary diagnosis when patient has an unusual amount of postoperative pain

19. Coding Diseases of the Nervous System Cerebral Palsy Nonprogressive, brain-damaging disturbance that originates during the prenatal and perinatal period Hemiplegia and Hemiparesis Paralysis of one side of the body Codes differentiate between flaccid and spastic hemiplegia Whether the dominant or nondominant side of the body is affected

20. Coding Diseases of the Nervous System Epilepsy and Recurrent Seizures Terminology that is the same as intractable is included Epilepsy is a disorder characterized by recurrent seizures A seizure is a transient disturbance of cerebral function caused by an abnormal paroxysmal neuronal discharge in the brain Recurrent seizures or seizure disorder are classified in the same category as epilepsy Conditions documented as convulsions, convulsive disorder, fits, recurrent convulsions are NOT equivalent to epilepsy or recurrent seizures and are instead coded to the symptom of ICD-10-CM

21. Coding Diseases of the Nervous System Migraine Recurrent headaches that produce moderate to severe head pain May be pulsing or throbbing and may appear on only one side May be present with nausea and vomiting Patient may experience an “aura” or a warning such as flashing lights or zigzag lines in their visual field that usually signals the person is about to have a migraine headache Many types of migraine headaches are identified with specific codes Other types of headaches have specific codes in ICD-10-CM as well

22. Coding Diseases of the Nervous System Intraoperative and Postprocedural Complications An example is cerebrospinal fluid leak from a spinal puncture. Other codes identify intraoperative hemorrhage or hematoma, accidental puncture of dura or other nervous system organ or postprocedural hemorrhage or hematoma that occurred during a nervous system procedure or affecting a nervous system organ during another procedure

23. ICD-10-PCS Procedure Coding for Chapter 6 Procedures performed on central nervous system are included in the tables 001–00X with root operations of bypass, change, destruction, division, drainage, excision, extirpation, extraction, fragmentation, insertion, inspection, map, release, removal, repair, reposition, resection, supplement, revision, and transfer. Procedures performed on peripheral nervous system include the root operations of release, repair, reposition, and transfer procedures

24. ICD-10-PCS Procedure Coding for Chapter 6 Examples of procedures Shunting of cerebral fluid from the brain to the peritoneal cavity is a “bypass” procedure Carpal tunnel release is a “release” procedure Neuroplasty or neurorrhaphy is coded to the root operations of repair or supplement depending on the particular procedure Transposition of a nerve is coded to reposition or transfer Nerve transfer is a “transfer” procedure

25. Exercise Practice coding the conditions included in Chapter 6 of ICD-10-CM for diseases of the nervous system as well as the procedures used to treat these conditions by completing the review exercises for Chapter 9.