Documenting Parkinson’s disease (PD) with the Correct ICD-10 Codes

Documenting Parkinson’s disease (PD) with the Correct ICD-10 Codes

The article lists the symptoms, diagnosis, and treatment of Parkinson’s disease along with the ICD-10 codes for accurately documenting this disorder. www.outsourcestrategies.com

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Parkinson’s disease (PD) is a progressive neurological disorder in which parts of the brain become progressively damaged over many years. This is a type of movement disorder that develops when the nerve cells in the brain do not produce enough of a brain chemical called “dopamine” (which is produced in a part of the brain called the “substantia nigra). The exact cause of PD is unknown, but several factors like genes, environmental triggers, the presence of Lewy bodies (within brain cells) and exposure to toxins appear to play a predominant role. Symptoms develop gradually and may begin with a barely-noticeable tremor in just one hand. People with PD may also experience stiffness or slowing of movement that may prevent them from carrying out movements as quickly as before. Although there is no specific cure for this neurological condition, medications can considerably reduce or improve the symptoms. Coding for PD can be challenging and for accurate clinical documentation of this condition, most neurological practices rely on medical coding outsourcing companies.

Parkinson’s News Today reports that about 10 million people worldwide suffer from this chronic neurological disorder. It is estimated that approximately 60,000 Americans are diagnosed with PD each year. PD usually appears between the ages of 50 and 60. Men are one and a half times more likely to get Parkinson’s disease than women. The potential risk factors include age, heredity, sex and exposure to toxins.

PD – Signs and Symptoms Initial symptoms usually appear on one side of your body and continue to become worse on that side even after symptoms begin to affect both sides. Primary symptoms include –     

Tremor Slowed movement (bradykinesia) Impaired posture and balance Rigid muscles Loss of automatic movements

Secondary symptoms of PD include –        

Blank facial expression A tendency to stoop or lean forward Cramping Writing and speech changes Swallowing difficulties (dysphagia) Decreased blinking and swallowing Reduced arm swinging when walking Involuntary movements and prolo-nged muscle contractions (dystonia)

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Drooling Fatigue Sexual dysfunction

Other signs and symptoms include - sleep problems, dementia, constipation, urinary incontinence, reduced sensation of pain and problems with attention and memory.

Diagnosis and Evaluation There is no specific test to diagnose Parkinson’s disease. A primary care physician or general practitioner will be usually the first healthcare professional to evaluate the symptoms. A detailed evaluation will be done by analyzing the initial signs and symptoms and examining the previous medical history of the patient. Generally, the symptoms will be mild during the early stages of PD and physicians may find it hard to definitively diagnose the condition. However, if Parkinson’s disease is suspected, the general physician will directly refer the patient to a neurologist.

Based on patient medical history, the neurologist will conduct a detailed review of symptoms along with a neurological and physical examination. Several diagnostic imaging tests such as MRI scan, CT scan, Single-photon emission computerized tomography (SPECT) scan, Ultrasound of the brain, Positron emission tomography (PET) scan, and blood tests may be performed to analyze symptoms and rule out other disorders.

Treatment Methods for PD Treatment methods include medications and incorporating several positive lifestyle changes. Medications like Carbidopa-levodopa, Dopamine agonists, Anticholinergics, Amantadine and MAO-B and COMT inhibitors will help people manage problems with walking, movement and tremor. These medications also increase or substitute for dopamine, a specific signaling chemical (neurotransmitter) in the brain. Taking adequate rest, exercise and consuming a balanced diet are important. Speech therapy, occupational therapy, and physical therapy can also help to improve communication and other related symptoms. Surgical interventions like deep brain stimulation (DBS) will be considered as a last resort for those patients who normally don’t respond to medications, therapies and other lifestyle changes.

ICD-10 Codes for Parkinson’s disease Neurologists who treat Parkinson’s patients must maintain clear and complete records about their diagnosis and treatment services provided. Neurology medical coding involves using the correct ICD-10 codes to report PD on the medical claims they submit to health insurers for reimbursement.

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Clinical documentation must also mention the specific type of Parkinson’s disease. The following ICD-10 codes are used to indicate a diagnosis of PD for reimbursement purposes – G20 – Parkinson’s disease ICD-10-CM code G20 is a specific code that can be used to specify a diagnosis and is applicable to –     

Hemiparkinsonism Idiopathic Parkinsonism or Parkinson’s disease Paralysis agitans Parkinsonism or Parkinson’s disease NOS Primary Parkinsonism or Parkinson’s disease

G21 – Secondary parkinsonism  

G21.0 – Malignant neuroleptic syndrome G21.1 – Other drug-induced secondary parkinsonism

G21.11 – Neuroleptic induced parkinsonism      

G21.19 – Other drug induced secondary parkinsonism G21.2 – Secondary parkinsonism due to other external agents G21.3 – Postencephalitic parkinsonism G21.4 – Vascular parkinsonism G21.8 – Other secondary parkinsonism G21.9 – Secondary parkinsonism, unspecified

Exclusion specific to G20: ‘Dementia with Parkinsonism’ is not included in the above set and has to be coded using G31.83.

If you are diagnosed with Parkinson's disease (PD), it is important to work closely with your physician to discuss the type of treatment modality you should follow. Appropriate and timely treatment can help to reduce the intensity of PD. A combination of medications followed by certain lifestyle changes such as healthy eating, regular physical exercise and avoiding falls may help make living with Parkinson's disease easier.

Treating and managing patients with Parkinson’s disease and taking care of the essential documentation requirements can be quite challenging for physicians. Managing neurology medical billing and coding tasks could be easier for physicians who partner with a professional medical billing and coding company that provides the services of AAPCcertified coding specialists.

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