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Chapter 6 Diseases & Disorders of Nervous Spring 2010

System & Sense Organs

Diseases of the Nervous Learning Objectives


System & Sense Organs 1. Identify inflammatory conditions of the
central nervous system
2. Define common sense organ disorders,
† Chapter 6: Categories 320-389 such as glaucoma, cataract, otitis, etc.
„ 320–326, Inflammatory diseases of the central
nervous system 3. Assign complete and accurate codes based
„ 330–337, Hereditary and degenerative diseases of on the documentation provided
the central nervous system 4. Identify hereditary and other disorders of
„ 340–349, Other disorders of the central nervous the nervous system, such as paralytic
system
„ 350–359, Disorders of the peripheral nervous system conditions, epilepsy, critical illness
„ 360–379, Disorders of the eye and adnexa neuropathy, etc.
„ 380–389, Disorders of the ear and mastoid process 5. Differentiate between acute and chronic
† Coding Guidelines: Section I.C.6.a. Pain pain
338.X
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Divisions of the Nervous System Divisions of the Nervous System


† Central Nervous System
†Peripheral Nervous System
„ Brain
† Protected by cranial bones and cranial meninges „ somatic nervous system (SNS)
† Cranial meninges – continuous with the spinal meninges
and have the same basic structure „ autonomic nervous system (ANS)
† CSF – nourishment and protection against chemical or † sympathetic division
physical injury for the brain and spinal cord, 4 CSF filled
cavities within the brain called ventricles † parasympathetic division
„ Spinal cord
† Protective coverings, bony vertebrae and tough
meninges
† Meninges – connective tissue coverings that encircle the
spinal cord and brain
† Epidural space – cushion of fat and connective tissue, a
space between the dura mater and the wall of the
vertebral canal
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Inflammatory Diseases: 320–326 Infectious Diseases of CNS


† Bacterial meningitis: 320.X † Dual classification often used
† Meningitis due to other organisms: 321.x „ Code for underlying condition sequenced
† Encephalitis: 323.X first, followed by a code for the
manifestation
† Intracranial and intraspinal abscess: 324.x
„ Important to check alpha & tabular
† Phlebitis and thrombophlebitis of indexes for instructions
intracranial venous sinuses: 325.x † Example – meningitis sarcoidosis
† Late effects of intracranial abscess or „ 135 + 321.4
pyogenic infection: 326 † 135 = sarcoidosis
„ Use additional code to identify condition † 321.4 = meningitis in sarcoidosis

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Chapter 6 Diseases & Disorders of Nervous Spring 2010
System & Sense Organs

Hereditary and Degenerative


Organic Sleep Disorders (327) Diseases of CNS (330–337)
† Organic insomnia † Long term chronic disability
† Organic hypersomnia † Numerous italicized codes
† Organic sleep apnea „ Code first underlying condition followed
by cerebral degeneration disorder
† Circadian rhythm sleep disorder
† May also produce psychiatric disorder
† Organic parasomnia
which would require an additional
† Organic sleep related movement code
disorders

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Hereditary and Degenerative


Diseases (330–337) Parkinson’s Disease: 332.x
† Primary: 332.0
† Examples „ Chronic, progressive disorder of the CNS
„ Alzheimer’s disease † Muscle rigidity
† Akinesia – difficulty in walking, taking small shuffling
„ Parkinson’s disease steps
† Depression and dementia
„ Huntington’s chorea † Tremor that begins in the fingers
† Secondary parkinsonism: 332.1
„ Cerebellar ataxia
„ Adverse effect of medication especially
„ Spinal muscular atrophy antipsychotic drugs
† Therapeutic Adverse Effect Code (E93X.X)
„ Motor neuron disease † E849.X Place of Occurrence
† ALS: Lou Gehrig’s disease † Medications
„ Levodopa, Sinemet, Antidepressants, Anticholinergic

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Motor Neuron Disease: 335.x Autonomic Dysreflexia: 337.3


† Amyotrophic Lateral Sclerosis: Lou Gehrig’s disease
335.20
† Life-threatening condition present in
„ Progressive denervation of upper and lower motor neurons spinal cord injuries
„ 5% of cases are inherited as an autosomal dominant trait „ Abrupt onset of excessively high blood
† Signs & Symptoms
„ Prominent and early muscle atrophy, progressive muscle
pressure
weakness, impaired speech, difficulty chewing, swallowing, „ Bradycardia, Blurred vision, sweating
breathing
† Medications † Takes precedence in sequencing of
„ Thyroid-releasing hormones to improve motor function;
Anticholinergic agent
codes
† Electromyography „ Use additional code to identify the cause
„ Muscle biopsy, CSF, Motor conduction studies, MRI, CT, † Decubitus ulcer, fecal impaction, UTI
myelogram

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Chapter 6 Diseases & Disorders of Nervous Spring 2010
System & Sense Organs

Pain: 338 Pain – Read Coding Guidelines for


Page 26-29: Coding Guidelines detail
1. Used in conjunction with other codes to provide a. Category 338 as Principal or First
more detail
„ Acute, chronic pain, neoplasm-related pain. listed diagnosis
† If pain is not specified as acute/chronic, do not b. Use of category 338 Codes in
use 338.x codes except for Conjunction with Site Specific Pain
„ post-thoracotomy pain,
„ postoperative pain or
Codes
„ neoplasm related pain. 2. Pain due to devices
† A code from subcategories 338.1 and 338.2 3. Postoperative Pain
should not be assigned if the underlying
(definitive) diagnosis is known, 4. Chronic Pain
„ unless the reason for the encounter is pain
control/management and not management of 5. Neoplasm related pain
the underlying condition. 6. Chronic Pain Syndrome

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Other Disorders of CNS (340–349) Epilepsy 345.XX


† Hemiplegia and hemiparesis † Recurrent brain dysfunction associated with abnormal
„ May be a single code when cause is unknown electrical discharges of the neurons in the brain
„ Usually the result of another illness or injury and
used as an additional code † 5th Digit for Status Epilepticus (intractable)
„ 5th Digit for Dominant versus nondominant „ the rapid succession of seizures so that one begins
„ Hemiplegia must be present at discharge for coding before the symptoms of the preceding one has ended
purposes with CVAs „ Intravenous Valium for seizures in progress
„ Late effects of CVA: 438.2X
† Medications
† Infantile cerebral palsy
† Quadriplegia, paraplegia, monoplegia „ Phenytoin (Dilantin), Valproic Acid, Carbemazepine
„ Usually the result of another illness or injury (Tegretol)
† Epilepsy † Diagnostic Tests
† Migraine headache „ EEG, CT & MRI Scans, Brain Scan, LP

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Epilepsy 345.XX Peripheral Nervous System: 350–359


† Code only when stated as “epilepsy” † Disorders of peripheral and cranial
„ Do not code possible epilepsy to epilepsy nerves
„ Otherwise, use 780.3X † Polyneuropathies
† Review Index † Neuralgia, neuritis, radiculitis
„ Disorder, seizure, recurrent † Acquired and congenital/hereditary
† Codes to epilepsy conditions
„ Seizure
† Several italicized codes to indicate
† Recurrent 345.9
code first underlying condition
† Repetitive 780.39
„ Code condition first, manifestation second
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Chapter 6 Diseases & Disorders of Nervous Spring 2010
System & Sense Organs

Peripheral Nervous System: 350–359 Trigeminal Neuralgia


† Examples † Painful disorder of one or more
„ Bell’s palsy branches of the trigeminal nerve
„ Brachial plexus lesions characterized by sudden, paroxysmal
„ Carpal tunnel syndrome attacks of excruciating facial pain
„ Peroneal muscular atrophy † Medications
„ Polyneuropathy caused by other diseases „ phenytoin, narcotics, carbamazepine
„ Myasthenia gravis † Lab tests
„ Congenital muscular dystrophy „ CT scan, tomography

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Bell’s Palsy Carpal Tunnel Syndrome: 354.0


† Unilateral facial paralysis or weakness † Compression of the median nerve in the
flexor compartment of the wrist by the
resulting in facial distortion transverse carpal ligament
† Medications † Signs & symptoms
„ pain and burning or tingling in the fingers
„ prednisone „ inability to clench hand into a fist,\
† Lab Tests „ worse at night and in the morning
† Medications
„ electromyography „ Analgesics, corticosteroids
† Lab tests
„ Electromyography, nerve conduction velocity
test

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Critical Illness Polyneuropathy: 357.82 Critical Illness Myopathy: 359.81


† Commonly associated with † Difficulty in weaning patients from
complication of sepsis and multiple mechanical ventilation
organ failure † Associated with neuromuscular
† Can be secondary to SIRS blocking agents, corticosterioids, and
† Synonyms for CIP are neuropathy
„ neuropathy of critical illness, † Additional E-code for Drug
„ ICU neuropathy „ Poisoning
„ ICU polyneuropathy „ Therapeutic Adverse Effect

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Chapter 6 Diseases & Disorders of Nervous Spring 2010
System & Sense Organs

Disorders of the Eye and Adnexa Disorders of the Eye and


(360–369) Adnexae: (360–369)
† Knowledge of eye anatomy important † Visual impairment – classified
† Common conditions according to severity
„ Numerous infections † List eye with best vision first, followed
„ Various forms of retinopathy by code for lesser eye
„ Cystoid macular degeneration
† Legal blindness in the U.S. – severe
„ Glaucoma
„ Cataract
or profound impairment of both eyes
„ Blindness and low vision
„ Keratitis and conjunctivitis

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Corneal Injury Conjunctivitis


† Corneal flash burn, photokeratitis, † Due to infection, allergy, foreign
ultraviolet keratitis: 370.24 object, or other cause
„ Due to sun exposure or ultraviolet light exposure
or welder’s eye burn † Can be due to other conditions, like
„ Assign E926.2 as additional code, E849.X Bell’s Palsy – coded to exposure
† Cornea-scleral Lacerations keratoconjunctivitis
„ Classify to open wound 871.9
„ Assign E codes for external cause of injury and
place of occurrence

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Operations on Extraocular Muscles Cataract: 366.X


† Type † Gradual development of opacity of the
crystalline lens of the eye with painless loss
1. Recession -- lengthening of vision
2. Resection -- shortening † Senile, traumatic, or toxic
† Number of muscles involved † S&S – halos around lights, poor reading
vision, altered color perception
† If procedure is done on both eyes
† No medications
„ code twice in ICD 9-CM
† Lab tests – penlight exam of lens & pupil,
slit-lamp biomicroscopy, visual acuity test,
A-scan & B-scan ultrasonography

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Chapter 6 Diseases & Disorders of Nervous Spring 2010
System & Sense Organs

Disorders of the Ear and Mastoid


Glaucoma: 365.xx Process (380–389)
† An eye disorder characterized by increased † External ear
intraocular pressure (IOP) that impairs „ Infections, cholesteatoma, impacted cerumen
vision
„ Open-angle glaucoma – blurred vision, haloes, † Middle and inner ear
pain, headaches „ Infections (otitis media), obstructions,
„ Angle-closure glaucoma – rapid loss of sight, dysfunction
sudden onset of severe head and eye ache, † Mastoiditis
cloudy cornea
† Medications † Disorders of tympanic membrane
„ Epinephrine, Pilocarpine, Beta-adrenergic † Vertiginous syndrome
blockers, Hyperosmotic agents † Tinnitus
† Tests
„ Slit lamp exam, Measure IOP, Tonography
† Deafness and hearing loss

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Acute swimmer’s ear (infective


Deafness & Hearing Loss otitis external): 380.12
† Hearing Loss † Inflammation of the skin of the
1. Conductive
† defect in conductive apparatus of the ear
external ear canal
2. Sensorineural † Signs & Symptoms:
† defect in sensory mechanism of the ear or „ Fever, moderate to severe ear pain, foul-
nerves
3. Mixed conductive and sensorineural smelling ear discharge, hearing loss
† Hearing Devices † Medications
1. External hearing aids „ Neomycin, Antibiotics, Analgesics
2. Implantable bone conduction devices
3. Implantable cochlear prosthetic devices † Tests – otoscopy, C&S

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Otitis Media: 381 to 382 Other Chapters


† Inflammation of the middle ear † Traumatic Injuries:
† acute – viral or bacterial infections † Open Wounds
„ bulging, fluid in middle ear, deep, throbbing ear † 870.X: Ocular Adnexa
pain, URI, fever, hearing loss, dizziness † 871.X: Eyeball
† chronic –tympanic membrane perforation † 872.X: Ear
„ persistent drainage from ear, persistent † 906.0: Late Effect of Open Wound [to eye or
inflammation of the middle ear ear]
† serous – dysfunction of the Eustachian tube † 907.X: Late Effects of Injuries to Nervous
„ nonsuppurative fluid accumulation in middle ear System
† Medications: „ 850.x: Concussion
„ antibiotic, acetaminophen, decongestant therapy † Codes reflect how long unconscious
„ Injuries to Nerves and spinal cord
† Tests – otoscopy, pneumatoscopy
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Chapter 6 Diseases & Disorders of Nervous Spring 2010
System & Sense Organs

Other Chapters Other Chapters


† Poisonings by Drugs used to Treat Nervous † Nervous System Complication of Surgical &
System Disorders Medical Care: 997.0x
† 966.X: Anticonvulsants & Anti-Parkinsonism „ Code also condition, E Code for Surgical
† 967.X: Sedatives & Hypnotics Procedure & Place of Occurrence
† 968.X: Other CNS Depressants 7 Anesthetics
† Additional code for condition
† Personal History of Disease of Nervous
† E849.X for place of occurrence System & Sense Organs: V12.4X
† Therapeutic Adverse Effects of Drugs used to † Organ or Tissue Replaced
treat nervous system disorders † V43.0: Eye Globe
„ E936.X, E937.X, E938.X † V43.1: Lens
„ Dilantin Toxicity † States Following Surgery of Eye & Adnexa:
† Code for Effect, E936.1, E849.X for place of V45.6X
occurrence
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Other Chapters Surgical Procedures


† Fitting & Adjustment of Devices: V53.X † Chapter 1: Operations on Nervous System
„ Categories 01-05
„ Spectacles, contact lens, hearing aid
† Chapter 3: Operations on Eye
† Aftercare following surgery of nervous „ Categories 08-16
system & sense organs: V58.71 & V58.72 † Chapter 4: Operations on Ear
† Special Investigations & Examinations: „ Categories: 18-20
V72.0, V72.1 † 89.X Anatomic & Physiologic
„ Eyes & vision Measurements & Manual Exams– Nervous
System & Sense Organs
„ Ears & hearing
† 95.X: Opthalmologic & Otologic Diagnosis
† Special Screening for Neurological, Eye, & & Treatment
Ear Disease: V80.X
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