Neurology
ICD-10 CM Training
• ICD-10-CM will be valid for dates of service on or after October 1, 2015– Outpatient dates of service of October 1, 2015 and
beyond. – Inpatient hospital service claims, is effective for dates of
discharge after September 30, 2015
ICD-10-CM Compliance Dates
• Covered Entities– Everyone covered by the Health Insurance Portability
Accountability Act (HIPPA)
• Non-Covered Entities– Worker’s Compensation– Auto Insurance– Non covered HIPAA entities are exempt but are
encouraged to adapt the new code set
Covered and Non-Covered Entities
• 21 Chapters• Alpha-numeric codes; not case-sensitive
– Codes begin with Alpha letter, A-Z, excluding U– Common errors
• I verses 1• O verses 0
• “X” Placeholder• 3 to 7 characters
– Decimal following 3rd character
ICD-10 Code Structure
• Placeholder “X”– Used for future expansion of a code– Fills in empty characters when a 6th and/or 7th character
apply– The placeholder may be used in different scenarios but
should never serve as the final character.
Example: W19.XXXA Unspecified fall, Initial Encounter
ICD-10 Code Structure
• 7th Character– Provides specified information regarding the clinical visit– Is required for certain categories and must be reported in
the seventh position– May be alpha or numeric– Has different meanings depending on the coding category
ICD-10 Code Structure
• Laterality– Some ICD-10-CM codes indicate laterality, specifying
whether the condition occurs on the left, right or is bilateral.
– If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.
– If the side is not identified in the medical record, assign the code for the unspecified side.
OGCR section 1.B.13
ICD-10 Code Structure
• “Other” Codes– Codes titled “other” or “other specified” are for use when
the information in the medical record provides detail for which a specific code does not exist.
• “Unspecified” Codes– Codes titled “unspecified” are for use when the
information in the medical record is insufficient to assign a more specific code.
OGCR section 1.A.9.a.b
ICD-10 Code Structure
• Excludes Notes– Excludes1
• A type 1 Excludes note is a pure excludes note• It means “NOT CODED HERE”• The code excluded should never be used at the same time• When two conditions cannot occur together
– Excludes2• Represents “Not included here”• The condition excluded is not part of the condition represented
by the code• It is acceptable to use both the code and the excluded code
together, when appropriateOGCR section 1.A.12.a.b
ICD-10 Structure
• “Code First” and “Use Additional Code”– ICD-10 has a coding convention that requires the
underlying condition be sequenced first followed by the manifestation.
– These instructional notes indicate the proper sequencing order of the codes.
OGCR section 1.A.13
• The “-” indicates there are additional reporting options
ICD-10 Code Structure
Most Common Diagnosis Codes
Sleep apnea (adult) (pediatric)ICD-9 Code ICD-10 Code Description Excludes1 Excludes2
327.20 G47.30 Sleep apnea, unspecified
Applicable to:• Sleep apnea NOS
• Apnea NOS (R06.81)
• Cheyne-Stokes breathing (R06.3)
• Pickwickian syndrome (E66.2)
• Sleep apnea of newborn (P28.3)
• nightmares (F51.5)• nonorganic sleep disorders
(F51.-)• sleep terrors (F51.4)• sleepwalking (F51.3)
There are more specific code choice selections below: SEE NEXT SLIDE
Sleep apneaICD-9 Code ICD-10 Code Description Excludes1 Excludes2
327.21 G47.31 Primary central sleep apnea • Apnea NOS (R06.81)
• Cheyne-Stokes breathing (R06.3)
• Pickwickian syndrome (E66.2)
• Sleep apnea of newborn (P28.3)
• nightmares (F51.5)
• nonorganic sleep disorders (F51.-)
• sleep terrors (F51.4)
• sleepwalking (F51.3)
327.22 G47.32 High altitude periodic breathing
327.23 G47.33 Obstructive sleep apnea (adult) (pediatric)
327.24 G47.34 Idiopathic sleep related nonobstructive alveolar hypoventilation
Applicable To:• Sleep related hypoxia
327.25 G47.35 Congenital central alveolar hypoventilation syndrome
327.26 G47.36 Sleep related hypoventilation in conditions classified elsewhere
327.27 G47.37 Central sleep apnea in conditions classified elsewhere
327.29 G47.39 Other sleep apnea
Code also any associated underlying condition
• Type– Congenital central alveolar hypoventilation syndrome– Idiopathic sleep related non-obstructive alveolar
hypoventilation– Obstructive– Primary central– Central sleep apnea associated with underlying condition– Primary sleep apnea of newborn
Sleep Apnea Documentation Tips
ConvulsionsICD-9 Code ICD-10 Code Description Excludes1 Excludes2
780.39 R56.9 Unspecified convulsions
Applicable To:• Convulsion disorder• Fit NOS• Recurrent convulsions• Seizure(s) (convulsive)
NOS
N/A • abnormal findings on antenatal screening of mother (O28.-)
• certain conditions originating in the perinatal period (P04-P96)
• signs and symptoms classified in the body system chapters
• signs and symptoms of breast (N63, N64.5)
There are additional code choice selections:
780.31 R56.00 Simple febrile convulsions
780.32 R56.01 Complex febrile convulsions
780.33 R56.1 Post traumatic seizures
• Type– Simple febrile– Complex febrile– Post-traumatic
Convulsions Documentation Tips
Multiple sclerosisICD-9 Code ICD-10 Code Description Excludes1 Excludes2
340 G35 Multiple sclerosis
Applicable To:• Disseminated multiple
sclerosis• Generalized multiple
sclerosis• Multiple sclerosis NOS• Multiple sclerosis of brain
stem• Multiple sclerosis of cord
N/A• certain conditions originating in the
perinatal period (P04-P96)• certain infectious and parasitic diseases
(A00-B99)• complications of pregnancy, childbirth
and the puerperium (O00-O9A)• congenital malformations, deformations,
and chromosomal abnormalities (Q00-Q99)
• endocrine, nutritional and metabolic diseases (E00-E88)
• injury, poisoning and certain other consequences of external causes (S00-T88)
• neoplasms (C00-D49)• symptoms, signs and abnormal clinical
and laboratory findings, not elsewhere classified (R00-R94)
Parkinson's DiseaseICD-9 Code ICD-10 Code Description Excludes1 Excludes2
332.0 G20 Parkinson's disease• Hemiparkinsonism• Idiopathic
Parkinsonism or Parkinson's disease
• Paralysis agitans• Parkinsonism or
Parkinson's disease NOS
• Primary Parkinsonism or Parkinson's disease
• dementia with Parkinsonism (G31.83)
• certain conditions originating in the perinatal period (P04-P96)
• certain infectious and parasitic diseases (A00-B99)
• complications of pregnancy, childbirth and the puerperium (O00-O9A)
• congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
• endocrine, nutritional and metabolic diseases (E00-E88)
• injury, poisoning and certain other consequences of external causes (S00-T88)
• neoplasms (C00-D49)• symptoms, signs and
abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
• Type– Idiopathic G20– Primary G20– Secondary G21.19
– Due to• Drugs G21.19• External agents G21.2• Treatment induced G21.19• Vascular G21.4
– With Dementia G31.83• Without behavioral disturbance [F02.80]• With behavioral disturbance [F02.81]
Parkinson’s Dx. Documentation Tips
Carpal tunnel syndrome, unspecified upper limbICD-9 Code ICD-10
CodeDescription Excludes1 Excludes2
354.0 G56.00 Carpal tunnel syndrome, unspecified upper limb
• current traumatic nerve disorder - see nerve injury by body region
N/A
There are more specific code choice selections below:
G56.01 Carpal tunnel syndrome, right upper limb
G56.02 Carpal tunnel syndrome, leftt upper limb
• Laterality– Right– Left– Bilateral
Carpal Tunnel Syndrome Documentation Tips
Anesthesia of skinICD-9 Code ICD-10 Code Description Excludes1 Excludes2
782.0 R20.0 Anesthesia of skin • dissociative anesthesia and sensory loss (F44.6)
• psychogenic disturbances (F45.8)
• symptoms relating to breast (N64.4-N64.5)782.0 R20.1 Hypoesthesia of skin • dissociative anesthesia and sensory
loss (F44.6)• psychogenic disturbances (F45.8)
782.0 R20.2 Paresthesia of skin
Applicable To:• Formication• Pins and needles• Tingling skin
• dissociative anesthesia and sensory loss (F44.6)
• psychogenic disturbances (F45.8)• acroparesthesia (I73.8)
782.0 R20.3 Hyperesthesia • dissociative anesthesia and sensory loss (F44.6)
• psychogenic disturbances (F45.8)
782.0 R20.8 Other disturbances of skin sensation
• dissociative anesthesia and sensory loss (F44.6)
• psychogenic disturbances (F45.8)
782.0 R20.9 Unspecified disturbances of skin sensation
• dissociative anesthesia and sensory loss (F44.6)
• psychogenic disturbances (F45.8)
Localized-related (focal)(partial) epilepsy syndromes with complex partial seizures, with intractable epilepsy
ICD-9 Code ICD-10 Code Description Excludes1 Excludes2
345.41 G40.211 Localization-related (focal)(partial) epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus
• conversion disorder with seizures (F44.5)
• convulsions NOS (R56.9)• hippocampal sclerosis
(G93.81)• mesial temporal sclerosis
(G93.81)• post traumatic seizures
(R56.1)• seizure (convulsive) NOS
(R56.9)• seizure of newborn (P90)• temporal sclerosis
(G93.81)• Todd's paralysis (G83.8)
N/A
345.41 G40.219 Localization-related (focal)(partial) epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus
• conversion disorder with seizures (F44.5)
• convulsions NOS (R56.9)• hippocampal sclerosis
(G93.81)• mesial temporal sclerosis
(G93.81)• post traumatic seizures
(R56.1)• seizure (convulsive) NOS
(R56.9)• seizure of newborn (P90)• temporal sclerosis
(G93.81)• Todd's paralysis (G83.8)
N/A
Localization-related (focal)(partial) epilepsy and epileptic syndromes, with complex partial seizures, without mention of intractable epilepsyICD-9 Code ICD-10 Code Description Excludes1 Excludes2
345.40 G40.201 Localization-related (focal)(partial) epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus
• conversion disorder with seizures (F44.5)
• convulsions NOS (R56.9)• hippocampal sclerosis
(G93.81)• mesial temporal sclerosis
(G93.81)• post traumatic seizures
(R56.1)• seizure (convulsive) NOS
(R56.9)• seizure of newborn (P90)• temporal sclerosis
(G93.81)• Todd's paralysis (G83.8)
N/A
345.40 G04.209 Localization-related (focal)(partial) epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus
• conversion disorder with seizures (F44.5)
• convulsions NOS (R56.9)• hippocampal sclerosis
(G93.81)• mesial temporal sclerosis
(G93.81)• post traumatic seizures
(R56.1)• seizure (convulsive) NOS
(R56.9)• seizure of newborn (P90)• temporal sclerosis
(G93.81)• Todd's paralysis (G83.8)
N/A
Generalized convulsive epilepsy with intractable epilepsyICD-9 Code ICD-10 Code Description Excludes1 Excludes2
345.10 G40.311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus
• conversion disorder with seizures (F44.5)
• convulsions NOS (R56.9)• hippocampal sclerosis
(G93.81)• mesial temporal sclerosis
(G93.81)• post traumatic seizures
(R56.1)• seizure (convulsive) NOS
(R56.9)• seizure of newborn (P90)• temporal sclerosis
(G93.81)• Todd's paralysis (G83.8)
N/A
345.10 G40.319 Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus
• conversion disorder with seizures (F44.5)
• convulsions NOS (R56.9)• hippocampal sclerosis
(G93.81)• mesial temporal sclerosis
(G93.81)• post traumatic seizures
(R56.1)• seizure (convulsive) NOS
(R56.9)• seizure of newborn (P90)• temporal sclerosis
(G93.81)• Todd's paralysis (G83.8)
N/A
Generalized convulsive epilepsy without mention of intractable epilepsyICD-9 Code ICD-10 Code Description Excludes1 Excludes2
345.10 G40.301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus
• conversion disorder with seizures (F44.5)
• convulsions NOS (R56.9)• hippocampal sclerosis
(G93.81)• mesial temporal sclerosis
(G93.81)• post traumatic seizures
(R56.1)• seizure (convulsive) NOS
(R56.9)• seizure of newborn (P90)• temporal sclerosis
(G93.81)• Todd's paralysis (G83.8)
N/A
345.10 G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus
• conversion disorder with seizures (F44.5)
• convulsions NOS (R56.9)• hippocampal sclerosis
(G93.81)• mesial temporal sclerosis
(G93.81)• post traumatic seizures
(R56.1)• seizure (convulsive) NOS
(R56.9)• seizure of newborn (P90)• temporal sclerosis
(G93.81)• Todd's paralysis (G83.8)
N/A
• Status Epilepticus– With or without
• Intractability– Intractable– Not intractable
• Epilepsy Type– Absence syndrome– Due to external causes– Epileptic spasms– Generalized idiopathic– Juvenile myoclonic– Lennox-Gastaut– Partial idiopathic, localized onset
• Partial Seizure Type– With complex partial seizures– With simple partial seizures
• Note: The following terms are to be considered equivalent to intractable: pharmacoresistant (pharmacologically resistant), treatment resistant, refractory (medically) and poorly controlled.
Epilepsy Documentation Tips
Idiopathic Progressive PolyneuropathyICD-9 Code ICD-10 Code Description Excludes1 Excludes2
356.4 G60.3 Idiopathic progressive neuropathy
• neuralgia NOS (M79.2)
• neuritis NOS (M79.2)
• peripheral neuritis in pregnancy (O26.82-)
• radiculitis NOS (M54.10)
N/A
Thoracic or lumbosacral neuritis or radiculitis, unspecifiedICD-9 Code ICD-10 Code Description Excludes1 Excludes2
724.4 M54.14 Radiculopathy, thoracic region
• current injury - see injury of spine by body region
• discitis NOS (M46.4-)
• arthropathic psoriasis (L40.5-)• certain conditions originating in the perinatal
period (P04-P96)• certain infectious and parasitic diseases (A00-B99)• compartment syndrome (traumatic) (T79.A-)• complications of pregnancy, childbirth and the
puerperium (O00-O9A)• congenital malformations, deformations, and
chromosomal abnormalities (Q00-Q99)• endocrine, nutritional and metabolic diseases (E00-
E88)• injury, poisoning and certain other consequences
of external causes (S00-T88)• neoplasms (C00-D49)• symptoms, signs and abnormal clinical and
laboratory findings, not elsewhere classified (R00-R94)
There are more specific code choice selections below:
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M51.14 Intervertebral disc disorders with radiculopathy, thoracic region
M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
• Spinal Region– Thoracic– Thoracolumbar– Lumbar– Lumbosacral
Thoracic or Lumbosacral Neuritis or Radiculitis Documentation Tips
Respiratory Abnormality otherICD-9 Code ICD-10 Code Description Excludes1 Excludes2
786.09 R06.89 Other abnormalities of breathing
• acute respiratory distress syndrome (J80)
• respiratory arrest (R09.2)• respiratory arrest of newborn
(P28.81)• respiratory distress syndrome of
newborn (P22.-)• respiratory failure (J96.-)• respiratory failure of newborn
(P28.5)
N/A
There are additional code choice selections:R06.00 Dyspnea, unspecified
R06.01 Orthopnea
R06.02 Shortness of breath
R06.09 Other forms of dyspnea
R06.1 Stridor
R06.2 Wheezing
R06.3 Periodic breathing
R06.4 Hyperventilation
R06.5 Mouth breathing
R06.6 Hiccough
R06.7 Sneezing
R06.81 Apnea, not elsewhere classified
R06.82 Tachypnea, not elsewhere classified
R06.83 Snoring
• Use of symptom codes– Codes that describe symptoms and signs are acceptable for reporting purposes when a
related definitive diagnosis has not been established (confirmed) by the provider.
• Use of a symptom code with a definitive diagnosis code– Codes for signs and symptoms may be reported in addition to a related definitive
diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.
– Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.
• Combination codes that include symptoms– ICD-10-CM contains a number of combination codes that identify both the definitive
diagnosis and common symptoms of that diagnosis. When using one of these combination codes, an additional code should not be assigned for the symptom.
Documentation Tips
Amyotrophic Lateral SclerosisICD-9 Code ICD-10 Code Description Excludes1 Excludes2
335.20 G12.21 Amyotrophic lateral sclerosis
• certain conditions originating in the perinatal period (P04-P96)
• certain infectious and parasitic diseases (A00-B99)
• complications of pregnancy, childbirth and the puerperium (O00-O9A)
• congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
• endocrine, nutritional and metabolic diseases (E00-E88)
• injury, poisoning and certain other consequences of external causes (S00-T88)
• neoplasms (C00-D49)• symptoms, signs and
abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
N/A
Lesion of Ulnar NerveICD-9 Code ICD-10 Code Description Excludes1 Excludes2
354.2 G56.20 Lesion of ulnar nerve, unspecified upper limb
• current traumatic nerve, nerve root and plexus disorders - see Injury, nerve by body region
• neuralgia NOS (M79.2)
• neuritis NOS (M79.2)
• peripheral neuritis in pregnancy (O26.82-)
• radiculitis NOS
• certain conditions originating in the perinatal period (P04-P96)
• certain infectious and parasitic diseases (A00-B99)
• complications of pregnancy, childbirth and the puerperium (O00-O9A)
• congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
• endocrine, nutritional and metabolic diseases (E00-E88)
• injury, poisoning and certain other consequences of external causes (S00-T88)
• neoplasms (C00-D49)• symptoms, signs and abnormal
clinical and laboratory findings, not elsewhere classified (R00-R94)
There are additional code choices:
G56.21 Lesion of ulnar nerve, right upper limb
G56.22 Lesion of ulnar nerve, left upper limb
• Laterality– Left– Right– Bilateral
Lesion of Ulnar Nerve Documentation Tips
Essential and other specified forms of tremorICD-9 Code ICD-10 Code Description Excludes1 Excludes2
333.1 G25.0 Essential tremor
Applicable to:• Familial tremor
• tremor NOS (R25.1)
• Sleep related movement disorders (G47.6-)
333.1 G25.1 Drug-induced tremor
Applicable To:• Familial tremorUse additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
333.1 G25.2 Other specified forms of tremor
Applicable to:• Intention tremor
Syncope and collapseICD-9 Code ICD-10 Code Description Excludes1 Excludes2
780.2 R55 Syncope and collapse
Applicable To:• Blackout• Fainting• Vasovagal attack
• cardiogenic shock (R57.0)• carotid sinus syncope
(G90.01)• heat syncope (T67.1)• neurocirculatory asthenia
(F45.8)• neurogenic orthostatic
hypotension (G90.3)• orthostatic hypotension
(I95.1)• postprocedural shock
(T81.1-)• psychogenic syncope
(F48.8)• shock NOS (R57.9)• shock complicating or
following abortion or ectopic or molar pregnancy (O00-O07, O08.3)
• shock complicating or following labor and delivery (O75.1)
• Stokes-Adams attack (I45.9)• unconsciousness NOS
(R40.2-)
• abnormal findings on antenatal screening of mother (O28.-)
• certain conditions originating in the perinatal period (P04-P96)
• signs and symptoms classified in the body system chapters
• signs and symptoms of breast (N63, N64.5)
• Type– Carotid sinus syncope– Heat syncope
• Initial encounter• Subsequent encounter• sequela
– Psychogenic syncope– Stokes-Adams syncope– Vasovagal syncope
Syncope Documentation Tips
All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.
• Site specificity• Document notation of qualifiers
– Exacerbation– Manifestations– Relapse– Status– Stages
• Indicate acute or chronic• Indicate underlying or external cause factors
– Medication– Smoke– Accidents– Mechanical failure
• Laterality– Bilateral– Right – Left
Documentation – Start Now
• Episode of Care for injuries, poisoning, external causes and other conditions– Initial Encounter
• Use while the patient is receiving active treatment of the condition– Active treatment includes surgical treatment, an emergency encounter, and
evaluation and treatment by a new physician
– Subsequent Encounter• Used on encounter after the patient has received active treatment of
the condition and is receiving routine care for the condition during the healing or recovery phase.
– Medication adjustments, aftercare, device adjustments, cast change
– Sequela• Used for complications or conditions that arise as a direct result of a
condition, late effect
Documentation – Start Now
• Combination codes that capture– Etiology and manifestation– Related conditions– Disease, injury or other medical condition and
complications– Disease or other medical conditions and common signs or
symptoms
• Add ICD-10 Codes to patient Problem List
Documentation – Start Now
UnderdosingUnderdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”).
Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.
Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known.
OGCR Section 1.C.19.e.5.c
Official Guidelines for Coding and Reporting
Centers for Disease Control and Prevention (ICD-10-CM)http://www.cdc.gov/nchs/icd/icd10cm.htm
Questions