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May 3, 2004
Coding
for Meningitis
Vol. 16 No. 9 p. 39
Meningitis is an infection and inflammation of the membranes and
fluid that cover the brain and spinal cord. Such inflammation may
involve all three meningeal membranes: the dura mater, arachnoid,
and pia mater. The inflammation of these individual membranous coverings
are termed pachymeningitis, arachnoiditis, and leptomeningitis,
and all are included in the meningitis ICD-9-CM code. The Alphabetic
Index in ICD-9-CM directs the coder to “see also meningitis”
for any one of these inflammations.
Coding Aspects of Meningitis
Meningitis can be caused by bacteria, virus, fungal infection, head
trauma, brain tumor, or certain inflammatory diseases such as lupus.
Sometimes a single code can identify both the meningitis and the
organism involved. However, it is common to assign two codes to
completely identify the diagnosis with the code for the underlying
condition sequenced first followed by a manifestation code. According
to AHA Coding Clinic for ICD-9-CM, “in those instances
where the infectious organism code in chapter 1 does not specify
meningeal involvement, an additional code from category 321 is used.”
(AHA Coding Clinic for ICD-9-CM, 1987, January-February,
pages 6-7.) For example, cryptococcal meningitis requires two codes
of 117.5 and 321.0 since code 117.5 identifies only the organism
and not the presence of meningitis. In addition, “Codes from
chapter 1 take precedence over codes from other chapters for the
same condition.” (ICD-9-CM Coding Handbook,
Faye Brown, 2004, page 83.) For example, meningitis due to candidiasis
is assigned to code 112.83 and meningococcal meningitis is assigned
to code 036.0.
Bacterial Meningitis
• Pneumococcal meningitis (320.1) is caused by the Streptococcus
pneumoniae bacteria. It can result from an ear infection, head injury,
or upper respiratory infection (URI). The Prevnar 7 vaccine (V03.82)
is a vaccine that can prevent pneumococcal meningitis.
• Hemophilus influenzae meningitis (320.0) was the leading
cause of bacterial meningitis before the use of hemophilus influenza
type b (Hib) vaccine. It is caused from URI, otitis media, or sinusitis.
If a patient receives the Hib vaccine, assign code V03.81.
• Meningococcal meningitis (036.0) is caused by the Neisseria
meningitidis bacteria. It commonly occurs when bacteria from a URI
enter the bloodstream. A vaccine is available to protect against
four of the five strains of bacteria (all but serogroup B) responsible
for meningococcal meningitis. Assign code V03.89 if a patient receives
this vaccination.
• Staphylococcal meningitis (320.3) usually develops as a
complication of a diagnostic or surgical procedure.
• Streptococcal meningitis (320.2) is caused by streptococcal
organisms. This should not be confused with pneumococcal meningitis
(320.1), which is caused by the Streptococcus pneumoniae bacteria.
• Listeria monocytogenes with meningitis (027.0 + 320.7) is
more susceptible in pregnant women, newborns, and older adults.
• Gram negative meningitis (320.82) includes the following
organisms:
- Enterobacter aerogenes
- Escherichia Coli
- Klebsiella
- Proteus
- Pseudomonas
Viral Meningitis
• Coxsackie virus (047.0) and echo virus (047.1) account for
roughly one-half of the cases of viral meningitis.
• Mumps meningitis (072.1) is a form of aseptic meningitis
caused by the mumps virus.
• Herpes simplex meningitis (054.72) is a form of meningitis
caused by the herpes virus type I.
• Herpes zoster with meningitis (053.0) is a form of meningitis
caused by herpes zoster.
• Aseptic meningitis (047.9) is a form of meningitis usually
caused by a virus. However, according to AHA Coding Clinic for ICD-9-CM,
“When no virus or other organism can be identified as the
cause of aseptic meningitis, category 322 is assigned for the inflammatory
condition.” (AHA Coding Clinic for ICD-9-CM, 1987, January-February,
pages 6-7.)
Other Types of Meningitis
• Cryptococcal meningitis (117.5 + 321.0) may affect people
with AIDS. If AIDS is associated with the cryptococcal meningitis,
sequence code 042 before codes 117.5 and 321.0. Other risk factors
for cryptococcal meningitis include lymphoma and diabetes. Cryptococcus
is a type of yeast found in soil worldwide. It is treated with intravenous
amphotericin B.
• Chronic meningitis (322.2) occurs when slow-growing organisms
such as the microorganisms (bacilli) invade the membrane and fluid
surrounding the brain. It persists over one month or longer and
usually affects people with AIDS or cancer or those who have engaged
in long-term use of prednisone.
Symptoms
Common symptoms of meningitis include high fever, severe headache,
nausea and vomiting, stiff neck, sensitivity to light (photophobia),
mental status changes/confusion, muscle pain, seizures, sore throat,
sleepiness/drowsiness/lethargy, agitation/irritability, and skin
rash (raised red or purple) near armpits or on hands and feet.
Diagnosis
To establish a definitive diagnosis of meningitis, a lumbar puncture
may be performed to evaluate the cerebral spinal fluid, which will
show a low glucose level and elevated white blood cell count. It
will also identify the bacteria responsible for the meningitis.
X-ray or computed tomography of the skull, sinus, or chest may also
be done to diagnose meningitis.
Treatment
Bacterial meningitis can be lethal within hours, making accurate
diagnosis and treatment vital to the survival of the patient. Intravenous
antibiotics will be ordered for bacterial meningitis. Corticosteroids
may also be administered to suppress inflammation and prevent hearing
loss.
Since antibiotics are ineffective in viral meningitis,
treatment includes bed rest, maintenance of fluid and electrolyte
balance, analgesics to reduce fever and relieve body aches, and
exercises to combat residual weakness.
Coding and sequencing for meningitis are dependent
upon the physician documentation in the medical record and application
of the Official Coding Guidelines for inpatient care. Also, use
specific AHA Coding Clinic for ICD-9-CM and American Medical Association
CPT Assistant references to ensure complete and accurate coding.
— This information was prepared by Audrey
Howard, RHIA, of 3M Health Information Systems (800-367-2447), a
leading supplier of coding and classification systems to nearly
4,000 healthcare providers. The company and its representatives
do not assume any responsibility for reimbursement decisions or
claims denials made by providers or payors as the result of the
misuse of this coding information.
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