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Neurosurgery Coding Alert

ICD-10:
Look Out for these New and Revised Neurosurgery Codes in 2018

Begin preparations now to hit the ground running in October.

Oct. 2017, will bring about another set of new and revised code changes to the CMS 2018 ICD-10-CM.

Specifically, you will be required to incorporate 363 new codes, 142 deletions, and more than 250 revised codes into your coding repertoire.

While this year offers substantially fewer new diagnosis codes than last year, there’s enough neurosurgery-relevant material that you should consider beginning your 2018 ICD-10 preparations sooner, rather than later.

Know these New and Revised Codes

The ICD-10-CM coding changes as they relate to the neurosurgery specialty range from a revised surgical aftercare code to a brand-new code for a specific form of spinal stenosis. You will find some codes to be entirely new additions to the ICD-10-CM, but keep an eye out for other codes that have only changed via the descriptor, not the actual code itself.

Consider this list of neurosurgery-specific codes you’ll likely be using with a moderate to high degree of frequency:

Note this Spinal Surgery Aftercare Coding Revision

ICD-10 has made a subtle, but important revision to any aftercare services following spinal surgery. Remember not to use aftercare codes if the patient’s primary diagnosis code includes a seventh digit. For any other postoperative care following surgery on the spine, you should rely on this revised Z code in addition to the patient’s primary diagnosis code:

Aftercare (see also Care)

Following surgery (for) (on) ⇒

  • Z47.89, Spinal — Revision from Z48.89

ICD-10 Revises Progressive Spinal Amyotrophy Code

Make yourself aware of this coding change when handling a diagnosis of progressive spinal amyotrophy. “As long as the diagnosis includes the keyword ‘progressive,’ you will want to code both ‘amyotrophy’ and ‘atrophy’ with G12.25,” says Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. You will now differentiate this code from the amyotrophic lateral sclerosis (ALS) diagnosis code.

Amyotrophia, amyotrophy, amyotrophic

  • G12.25, Spinal progressive – Revision from G12.21

Slightly Altered Surgical Complications and Infections Code

Despite their lack of frequency, you’ll want to be aware of these changes in coding various complications following a surgical procedure. If a patient experiences an infection or stitch abscess of a wound closure in the postoperative period, you will now rely on code T81.4XX-.

Complication(s) (from) (of)

Procedure Surgical procedure

  • T81.4XX-, Wound infection
  • T81.4XX-, Stitch abscess

Infection, infected, infective (opportunistic)

Due to or resulting from surgery, operation wound, postoperative wound, postprocedural

  • T81.4XX-

Consider these Additional New and Revised Codes

As of Oct. 1, you will encounter a revised code for cranial nerve compression and a brand-new code for familiar motor neuron disease. Additionally, ICD-10 has added two new neonatal encephalopathy codes (one unspecified and one in diseases classified elsewhere).

As mentioned previously, ALS will now have its own code separate from that of progressive spinal amyotrophy. A final important change to the ICD-10-CM comes with a modification to lumbar spinal stenosis coding. In addition to a slight revision to lumbar stenosis without neurogenic claudication, ICD-10 is implementing a new code to incorporate a diagnosis of lumbar stenosis with neurogenic claudication.

Compression

Cranial nerve

  • G51.8, Seventh — Revision from G52.8

Disease, diseased - see also Syndrome

Motor neuron (bulbar) (mixed type) (spinal)

  • G12.24, Familial — New code

Encephalopathy (acute)

  • P91.819, Neonatal, unspecified — New code
  • P81.811, In diseases classified elsewhere — New code

Sclerosis, sclerotic

  • G95.89, Primary, lateral — Revision from G12.29

Lateral (amyotrophic) (descending) (spinal)

  • G12.23, Primary — New code

Spinal (cord) (progressive)

  • G12.23, Lateral, amyotrophic — Revision from G12.21

Stenosis, stenotic (cicatricial) - see also Stricture

Spinal

  • M48.061, Lumbar region [NOS] [without neurogenic claudication] — Revision from M48.06

            o M48.062, With neurogenic claudication — New code