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v1.0.0
ICD-10 Guide
ICD-10 CodesG36.0

G36.0

Billable

Neuromyelitis optica [Devic]

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G36.0 is a billable code used to indicate a diagnosis of neuromyelitis optica [devic].

Key Diagnostic Point:

Neuromyelitis optica (NMO), also known as Devic's disease, is a severe autoimmune demyelinating disorder primarily affecting the optic nerves and spinal cord. It is characterized by episodes of optic neuritis and transverse myelitis, leading to significant neurological impairment. Unlike multiple sclerosis (MS), which is a more common demyelinating disease, NMO is associated with the presence of aquaporin-4 (AQP4) antibodies in the serum, which target astrocytes in the central nervous system. The clinical presentation often includes sudden vision loss, weakness, sensory disturbances, and bladder dysfunction. Diagnosis is typically confirmed through clinical evaluation, MRI findings, and serological testing for AQP4 antibodies. Treatment strategies focus on immunomodulatory therapies, including corticosteroids, plasma exchange, and long-term immunosuppressive agents to prevent relapses and manage symptoms. Early recognition and treatment are crucial to minimize long-term disability and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from multiple sclerosis and other demyelinating diseases
  • Need for specific serological testing (AQP4 antibodies)
  • Variability in clinical presentation and severity
  • Potential for overlapping symptoms with other neurological conditions

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document serological testing results
  • Misdiagnosis due to symptom overlap with MS
  • Lack of detailed treatment plans and follow-up

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Comprehensive neurological examination findings, MRI results, and serological test results.

Common Clinical Scenarios

Patients presenting with acute vision loss and spinal cord symptoms.

Billing Considerations

Ensure clear documentation of AQP4 antibody testing and treatment response.

Ophthalmology

Documentation Requirements

Detailed visual assessments and imaging studies of the optic nerve.

Common Clinical Scenarios

Patients with optic neuritis and visual disturbances.

Billing Considerations

Document the correlation between visual symptoms and neurological findings.

Coding Guidelines

Inclusion Criteria

Use G36.0 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of clinical findings, diagnostic tests, and treatment plans
  • Include specific details about the patient's symptoms and the results of AQP4 antibody testing

Exclusion Criteria

Do NOT use G36.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

84182CPT Code

AQP4 antibody test

Clinical Scenario

Used to confirm diagnosis of NMO in patients presenting with demyelinating symptoms.

Documentation Requirements

Document the reason for testing and the results.

Specialty Considerations

Neurology specialists should ensure that the test results are included in the patient's medical record.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of neuromyelitis optica, improving the accuracy of data collection and treatment tracking. This specificity aids in better understanding the epidemiology and treatment outcomes of the disease.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neuromyelitis optica, improving the accuracy of data collection and treatment tracking. This specificity aids in better understanding the epidemiology and treatment outcomes of the disease.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    Neuromyelitis Optica Foundation

Coding & Billing References

  • •
    Neuromyelitis Optica Foundation

Frequently Asked Questions

What is the primary difference between NMO and multiple sclerosis?

The primary difference lies in the underlying pathology and serological markers. NMO is associated with AQP4 antibodies, while MS is characterized by different immune mechanisms and does not typically involve these antibodies.