Order up: You asked, and we’re delivering even more ICD-10-CM 2019 coverage, this time for neurology.
What’s new, starting Oct. 1, 2018, are 30 additions and revisions for clonic hemofacial spasm, developmental disorder screenings, and cerebral infarction codes, among others, says medical coding consultant Kim Garner-Huey. In an upcoming ProfEdOnDemand webinar, “2019 ICD-10 Coding Changes for Neurology,” Huey outlines the details of each as well as the documentation/claims strategies sure to please payers and earn timely reimbursement.
Note: While not an exhaustive list, we have here a preview of what’s to come. As you train up for the changes, keep an eye on the Center for Disease Control’s (CDC) website for updates to the codes. Updates can be made at any time, even after the implementation deadline.
Muster the Nerve to Distinguish Hemifacial Spasm Specifics
With the old code G51.3, Clonic hemifacial spasm, payers couldn’t tell which side of the face was affected. To correct this problem, G51.3 was deleted and replaced by:
- 31, right side of the face
- 32, left side of the face
- 33, bilateral
- 39, unspecified
Fully Grasp Amino-Acid Disorders ICD-10 Codes
Gone now is E72.8, Other specified disorders of amino-acid metabolism. Replacement codes are:
- 1, Disorders of gamma aminobutyric acid (GABA) metabolism
- 9, Other specified disorders of amino-acid metabolism
Pick Wisely: For the moment, there’s only one specific amino-acid disorders code in ICD-10-CM: GABA is a chief neurotransmitter in the central nervous system and is directly responsible for regulating muscle tone, among other things. If the documentation does not support a GABA disorder, use the “other” code.
Absorb New Developmental Delay Screening Codes
Pediatric neurology is going to see five code changes for 2019. Gone is Z13.4, Encounter for screening for certain developmental disorders in childhood. This code will now be replaced by 4 new screening codes:
- 40, Screening for unspecified developmental delays
- 41, Autism screening
- 42, Screening for global developmental delays (GDD)
- 49, Screening for other developmental delays
Lock down the terms: If you’re going to pick the right code, you’ll need to fully understand the differences between unspecified, global, and other developmental delays. To choose between “unspecified” and “other,” follow the 2019 ICD-10-CM Coding Guidelines. If neither term fits, go with code 42: GDDs are when children achieve milestones (such as walking or talking) later than what is perceived as “normal.”
R40.233: Catch Up to Revisions in Coma Scale Codes
The Glasgow Coma Scale is the most common way to describe how conscious a patient is after a traumatic brain injury. The ICD-10 codes that match up to this scale are found in R40, and they’ve undergone some changes for 2019. Nothing too dramatic, just the addition of the word “flexion” after the word “abnormal,” to better describe what exactly is abnormal.
The codes now read: Coma scale, best normal response, abnormal flexion [of the limbs to painful stimuli]
- 2330, unspecified time
- 2331, in the field [EMT or ambulance]
- 2332, at arrival to emergency department
- 2333, at hospital admission
- 2334, 24 hours or more after hospital admission
Learn What’s New with CADISIL
A big change for neurology coding is the addition of I67.850, Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADISIL). That’s a very long name for a blood vessel damage disorder. In patients with CADISIL, the condition affects the blood flow to small blood vessels. The muscle cells surrounding the vessels become abnormal and die. All this damage leads to migraines and visual disturbances, and in some cases epilepsy.
Review the Updated Cerebral Infarction Codes
For cerebral infarctions, minor wording edits, one deletion/replacement, and one new code are the order of the day: Cerebral infarction due to unspecified occlusion or stenosis
- 219, Unspecified vertebral artery (changed from “arteries”)
- 239, Unspecified carotid artery (changed from “arteries”)
Edits to other codes include:
- 333, Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries (“due” was added).
- 343, Cerebral infarction due to thrombosis of bilateral cerebellar arteries, (“due” was added).
- 89, Other cerebral infarction, replaces I63.8.
- Watch out for new code I63.81, Other cerebral infarction due to occlusion or stenosis of small artery.
Correct Any Errors Before Oct. 1, 2018
A lot is happening for the 2019 reimbursement period: MIPS is changing reimbursement rules, more payers want to see patient records, and there are continuous pushes to improve your office’s clinical documentation improvement (CDI) efforts, Huey notes. Start now to correct any errors costing your office—and be sure to upgrade your ICD-10 diagnosis coding to include updates. You’ll be grateful you did when the new reimbursement period rolls around.
