Codificación en Neurología Pediátrica (CIE-9) - Revista de Neurología

Introduction
Coding in Neuropediatrics based on the ICD-9, 5th ed. (2006)
In the above sections, child neurological diagnoses were listed in line with current
or proposed classifications, such as The International Classification of Headache
Disorders (2nd ed., 2004), Report of the ILAE Task Force on Classification and
Terminology (Engel J. Epilepsia 2001), and Vademecum Metabolicum (Zschocke/
Hoffmann, 2001).
The ICD-9-CM code structure consists of a 3-digit rubric for category, a 4-digit
rubric for subcategory, and a 5-digit rubric for subclassification, e.g.: 345, ‘partial
epilepsy’; 345.4, ‘partial epilepsy, with impairment of consciousness’; and 345.40,
‘partial epilepsy, with impairment of consciousness, without intractable epilepsy’.
In all cases, an effort was made to find the code that provided the best fit for the
respective diagnoses. No codes were invented by the WG, but it did take certain
liberties which nevertheless showed respect for general ICD-9-CM philosophy:
• The fourth digits, ‘.8’ corresponding to ‘other specified disorders belonging to
this category which have no direct entry’, and ‘.9’, which the ICD assigns to
‘unspecified disorder belonging to this category’, were used for disorders having
no other possible codes or direct index entries.
• DirectICD-9entriesforsomediagnoseswererespected,eventhoughtheywould
have fitted better into other subcategories which covered similar disorders, or
would have come under other categories in the new etiological classifications,
e.g., 759.81 direct ICD-9 entry for ‘Prader-Willi syndrome’, and for ‘Angelman
syndrome (deletion 15q11-13)’ 758.33, corresponding to ‘other autosomal
deletions’. While both should rightly have the same category or subcategory,
the ICD was nevertheless respected and the code assigned that best covered the
disorder which had no direct entry in the ICD.
• In cases where there were few codes to assign to wide-ranging diagnostic
classifications, we endeavored to group the diagnoses under some closely
related code (e.g., 345.0 for ‘absences’, ‘childhood absences’, ‘myoclonic
absences’ and ‘juvenile absences’). Furthermore, the 4th or 5th digit was
used with a different and more current meaning, since at times the ICD
subcategories and subclassifications make no sense whatsoever, e.g. ICD-9
4th digit: 345.4, partial epilepsy ‘with impairment of consciousness’; 345.5,
partial epilepsy ‘without mention of impairment of consciousness’. The
ICD-9 5th digit subclassification is used in these subcategories for: 0, ‘without
mention of intractable epilepsy’; 1, ‘with intractable epilepsy’. This was
adapted as follows: i) 345.40 for partial symptomatic epilepsy and 345.41 for
partial cryptogenic epilepsy; and ii) 345.50 for partial idiopathic epilepsy and
345.51 for partial familial epilepsy
• In cases where no direct entry could be found for an interesting diagnosis,
this was assigned an available code that was in some way related, e.g., ‘784.0’
‘secondary headache’ corresponding in the ICD-9 to ‘headache’. It is to be
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