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Neurosurgery Coding Alert


5 Tips Help You Navigate Common Neoplasm Dx and Avoid Denial Pileups

If the cerebral meninges tumor is benign, you would report D32.0.

Whether they are malignant or benign, it’s no secret that navigating ICD-10 codes for neoplasms can be one of the most challenging aspects of diagnosis coding. Not only do you have numerous codes to wade through, but you must also learn how to correctly read the Table of Neoplasms.

However, you don’t have to lose precious dollars when reporting neoplasms. Keep the neoplasm claims in tip-top shape in your neurosurgery practice with these quick tips.

Tip 1: Identify Location for Benign Neoplasms of Brain

If the physician makes a diagnosis of a benign neoplasm in a patient’s brain, you will report the appropriate code depending upon whether the tumor is located above or below the tentorium in the brain.

Infratentorial: If the benign tumor is located in the infratentorial region of the brain, then you will report D33.1 (Benign neoplasm of brain, infratentorial).

Supratentorial: If the benign tumor is located in the supratentorial region of the brain, then you will report D33.0 (Benign neoplasm of brain, supratentorial).

Unspecified: However, when the surgeon does not specify the location of the patient’s benign tumor, you should report code D33.2 (Benign neoplasm of brain, unspecified).

Tip 2: Focus on This Code for Benign Pineal Neoplasms

When the physician makes a diagnosis of a benign tumor of pineal gland, you should report D35.4 (Benign neoplasm of pineal gland).

Pineal gland defined:  The pineal gland is a structure in the brain that produces a hormone called melatonin which plays an important role in controlling sleep. Tumors in the pineal gland may grow to compress the surrounding structures. Depending upon the structures that the tumorous mass compresses, the patient may experience headaches, vomiting, visual disturbances, balance and coordination problems, and hormonal imbalances.

Tip 3: Catch Dx Codes for Benign, Malignant Cerebral Meninges Tumors

When the physician documents a tumor of the cerebral meninges, you must know if the tumor is benign or malignant because this will impact your code choice.

Benign: If the cerebral meninges tumor is benign, you would report D32.0 (Benign neoplasm of cerebral meninges). You should report D32.9 (Benign neoplasm of meninges, unspecified) when the physician does not specify the site of the benign meningeal tumor.

“While the unspecified code might be applied for a craniocervical junction meningioma that involves both cerebral and spinal meninges, it is always best to report the most specific diagnostic code when possible,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

Malignant: On the other hand, to report a malignant neoplasm of the cerebral meninges, you would report C70.0 (Malignant neoplasm of cerebral meninges).

Tip 4: Follow Steps to Correctly Report Malignant Neoplasms in Cranial Nerves

Reporting for malignant neoplasms in the cranial nerves can be challenging because there are 12 cranial nerves. However, you don’t have a corresponding code for each nerve, nor do you have a code encompassing all of them. So, when you submit claims for malignant neoplasms in the cranial nerve(s), you can navigate to the right code by adopting the following three steps:

  • Step 1: Identify which cranial nerve is involved.
  • Step 2: Look if there is a dedicated code for the cranial nerve involved.
  • Step 3: Check if you can be specific for right or left side involvement.

Don’t miss: When the physician documents the diagnosis of neoplasm in a cranial nerve, you should read the clinical record in detail and try to find out which cranial nerve was involved. The physician may document the involved cranial nerve in either number or nomenclature.

For example: The physician documents that the patient has a malignant neoplasm of her right olfactory nerve. The correct ICD-10 code for this diagnosis is C72.21 (Malignant neoplasm of right olfactory nerve).

Tip 5: Observe ICD-10 Code for Cauda Equina Malignant Neoplasm

For malignant neoplasms of the cauda equina, you would report C72.1 (Malignant neoplasm of cauda equina).

Cauda equina defined:  Cauda equina is the bundle of spinal nerves and spinal nerve roots that originate from the tip of the spinal cord. This bundle consists of nerve pairs that originate from second lumbar level to fifth sacral level, and the coccygeal nerve. This bundle has both sensory and motor nerves and supplies the pelvic organs, perineum, and lower limbs.