Knowledge Base Article

In this week’s article, we’re discussing a few of the changes for ICD-10-CM in the Nervous System (Chapter 6): Alzheimer’s Dementia, Epilepsy, Hemiparesis/Hemiplegia (Dominant vs. Non-Dominant), Migraine, Phantom Limb Pain and Sleep Apnea

Alzheimer’s Dementia

I-9: Alzheimer’s Dementia

• with behavioral disturbance (aggressive) (combative) (violent) (331.0 / 294.11)
• without behavioral disturbance (331.0 / 294.10)

NOTICE:

The category for Alzheimer’s disease (G30) has been expanded to reflect onset (early vs. late)

I-10: Alzheimer’s Dementia

• behavioral disturbance (G30.9 / F02.81)
• early onset (G30.0 / F02.81)
• late onset (G30.1 / F02.80)
• specified NEC (G30.8 / F02.80)

Epilepsy

Terms for Epilepsy have been updated to classify the disorder, e.g,

• Localization-related Idiopathic Epilepsy
• Generalized Idiopathic Epilepsy
• Special Epileptic Syndromes

Example:

I-9: Epilepsy, epileptic (idiopathic) (345.9)

Epilepsy, localization related (focal) (partial) and (epileptic syndromes)

• With
• Complex partial seizures (345.4)
• Simple partial seizures (345.5)

NOTICE:

Within each category, more specificity can be described to identify: Seizures of Localized Onset, Complex Partial Seizures, Intractable and Status Epilepticus.

I-10: Epilepsy, epileptic, epilepsia (attack) (cerebral) (convulsion) (fit) (seizure) (G40.909)

Epilepsy, localization-related (focal) (partial)

• Idiopathic (G40.009)
• With seizures of localized onset (G40.009)
• Intractable (G40.019)
• With status epilepticus (G40.011)
• Without status epilepticus (G40.019)
• Not intractable (G40.009)
• With status epilepticus (G40.001)
• Without status epilepticus (G40.009)

NOTE

Category G40, Epilepsy and Recurrent Seizures

The following terms are to be considered equivalent to intractable:

• Pharmacoresistent (pharmacologically resistant)
• Treatment resistant
• Refractory (medically)
• Poorly controlled

Hemiplegia and Hemiparesis  (Dominant vs. Non-Dominant Side)

This category is to be used only when the listed conditions are reported without further specification, or are stated to be old or longstanding but of unspecified cause. The category is also for use in multiple coding to identify these conditions resulting from any cause.                                      

I-9:

The following fifth-digits are for use with codes 342.0-342.9:

• 0 affecting unspecified side
• 1 affecting dominant side
• 2 affecting non-dominant side

I-10:

Per ICD-10-CM Official Coding Guidelines: Codes from category G81, Hemiplegia and hemiparesis, and subcategories, G83.1, Monoplegia of lower limb, G83.2, Monoplegia of upper limb, and G83.3, Monoplegia, unspecified, 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 system 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

Example: G81.9 Hemiplegia, unspecified

• G81.90:  Hemiplegia, unspecified affecting unspecified side
• G81.91:  Hemiplegia, unspecified affecting right dominant side
• G81.92:  Hemiplegia, unspecified affecting left dominant side
• G81.93:  Hemiplegia, unspecified affecting right non-dominant side
• G81.94:  Hemiplegia, unspecified affecting left non-dominant side

            Excludes1: Hemiplegia and hemiparesis due to sequela of cerebrovascular disease

Migraine

I-9: Migraine, Unspecified (Idiopathic) (346.9x)

I-10: Migraine, Unspecified (Idiopathic) (G43.909)

NOTE

Category G43, Migraine

The following terms are to be considered equivalent to intractable:

• Pharmacoresistent (pharmacologically resistant)
• Treatment resistant
• Refractory (medically)
• Poorly controlled

Phantom Limb

The sensation that an amputated or missing limb is still attached to the body and is moving along with other body parts. An estimated 60% to 80% of people that have had an amputation, experience phantom sensations in the amputated limb with the majority being painful.  

I-9: Phantom limb (syndrome) (353.6)

NOTICE:

I-10 has given us the ability to identify whether pain is present or not after an amputation.

I-10: Phantom limb syndrome (G54.7)

• with pain (G54.6)
• without pain (G54.7)

Sleep Apnea

Sleep Apnea has its own subcategory with fifth character specificity identifying the type

Example:      

I-9: Sleep Apnea, Unspecified (780.57)

• with
• Hypersomnia, unspecified (780.53)
• Hyposomnia, unspecified (780.51)
• Insomnia, unspecified (780.51)
• Sleep disturbance (780.57)
• Central, in conditions classified elsewhere (327.27)
• Obstructive (adult) (pediatric) (327.23)
• Organic (327.20)
• other (327.29)
• Primary central (327.21)

I-10: Sleep Apnea, Unspecified (G47.30)

• Central (primary) (G47.31)
• in conditions classified elsewhere (G47.37)
• Obstructive (adult) (pediatric) (G47.33)
• Primary central (G47.31)
• Specified NEC (G47.39)

As you can see, there are several new terms and descriptions in the Nervous System Chapter for I-10-CM, providing more specificity and better clarity of certain conditions. If we can take just a little extra time assigning diagnosis codes for I-10, we will reflect the true severity of illness (SOI) for each and every patient.

Resources:

ICD-10-CM Coding Book by Ingenix

AHIMA ICD-10-CM Training Manual

Wikipedia