Changes to ICD-9-CM Announced

July 29, 2009

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PowersBy Laura B. Powers, MD, FAAN

The National Center for Health Statistics (NCHS) has published the annual Addenda to ICD-9-CM. These diagnosis-coding changes will become effective on October 1, 2009. The Coding Subcommittee of the Medical Economics and Management Committee was active this year in advocating changes beneficial to neurologists.

Epilepsy codes have long required fifth digits to describe whether or not the patient is "intractable." Because this term is not universally used, we now have other terms accepted as being synonymous with "intractable." These include:

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

Also, there will be a specific new code for mesial temporal, hippocampal, and temporal sclerosis. Subcommittee members worked with the AAN's Epilepsy Section and the National Association of Epilepsy Centers to request these changes.

Neonatal hypoxic-ischemic encephalopathy will be broken out into fifth digits to describe "mild," "moderate," and "severe" forms.

Additionally, inclusion body myositis and dysarthria will now have their own codes. Many terms have been added to the index to make coding easier, including palatal myoclonus, leukoaraiosis, autonomic diabetic neuropathy, and pneumocephalus.

The Academy has been working with NCHS, the Department of Defense, and the Veterans Administration regarding coding for traumatic brain injury (TBI). There are some changes useful to Academy members, such as V-codes to describe a history of TBI and screening for TBI, but the long awaited additional symptom codes to describe cognitive changes, which could have been used for any neurologic disorder, have not yet been approved. We will continue to advocate for these potentially beneficial codes.

Addenda to ICD-9-CM for October 1, 2009

Author Disclosure

Within the past 24 months, Dr. Powers served as an expert witness in two separate court cases.