1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 12 Coding for Diseases of the Nervous System and Sense Organs

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Diseases of the Nervous System and Sense Organs Diseases of the nervous system and sense organs are included in code section 320 to 389 of chapter 6, in the Disease Tabular of ICD-9-CM

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Inflammatory Disorders of the Central Nervous System (CNS) Meningitis (category 320 to 322) –Inflammation of the meninges (dura mater, arachnoid, pia mater) –Often mandatory dual coding is used to describe the underlying condition and manifestation (cryptococcal meningitis: 117.5 + 321.0) Encephalitis (category 323) –Inflammation of the brain; often caused by viruses

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Degenerative Diseases of the CNS Parkinson’s disease (332.0) –Degeneration of the nerves in the brain; deficiency of dopamine (a neurotransmitter). Characterized by tremors (e.g., “pill-rolling”), cogwheel rigidity, muscle weakness, slowness. –Secondary Parkinsonism (332.1) Secondary to another disease or can occur as an adverse effect of the therapeutic use of medications Alzheimer’s disease (331.0) –Progressive degenerative brain disorder with amyloid (protein) plaques (“tangles & bundles”) that destroy brain cells. Characterized by significant memory loss, anxiety with depression, wandering, behavioral disturbances. –Additional code is used to describe Alzheimer’s dementia with or without behavioral disturbance (331.0 + 294.11) (331.0 + 294.10)

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Diseases of the CNS Amyotrophic lateral sclerosis (ALS) (335.20) –Lou Gehrig’s disease (named after a famous baseball player who had the disease) –Degeneration of motor nerves causes progressive paralysis and respiratory muscles become affected. Multiple sclerosis (MS) (340) –The myelin sheath around nerves in CNS is destroyed (demyelinization); this prevents proper conduction of nerve impulses in the body. Characterized by gait disturbances, paresthesias (e.g., tingling, numbness), muscle weakness and paralysis, visual and speech disturbances. Marked by remissions and relapses.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Diseases of the CNS Hemiplegia and hemiparesis (342.XX) - Paralysis of one side of the body - Fourth digit conveys type or form (e.g., spastic) Epilepsy (category 345) -Never automatically code a diagnosis of seizure or convulsion to epilepsy. As of October, 2006, if the diagnosis is “recurrent seizures” or “seizure disorder” (even in the absence of term “epilepsy”), a code from category 345 (Epilepsy and Recurrent Seizures) is assigned. However, if the diagnosis is that of a single, isolated seizure or that of convulsions, the code assigned remains 780.39. - The 4 th digit assignment added to category 345 describes various types of epilepsy that can be further specified as intractable (hard to control by conventional treatments) by the 5 th digit “1.”

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the PNS Acute infective polyneuritis (357.0) –Guillain-Barré syndrome –Thought to be an autoimmune disorder (sometimes occurring after viral illness) –Rapidly progressive weakness and paralysis that begins in the legs and moves to the upper body, eventually affecting the respiratory muscles (e.g., diaphragm)

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Eye and Adnexa Blindness (code category 369) –Loss of vision –Usually a secondary diagnosis Cataracts (code category 366) –Cloudiness of the inner lens of the eye –Can be associated with age, be congenital, or be secondary to trauma or diabetes Glaucoma (code category 365) –Increased intraocular pressure –Acute, chronic, angle-closure, open-angle, and others

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Eye and Adnexa Strabismus –Inability of eyes to remain balanced (“cross- eyed”)(e.g., exotropia = outward deviation, esotropia = inward deviation) Macular degeneration (362.5X) –Degeneration of the macular area causing loss of central vision –Age related (leading cause of blindness in elderly) –Wet versus dry forms Retinal detachment (361.0X, 361.9) –Results in a retinal tear (usually treated with scleral buckle procedure)

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Ear Impacted cerumen 380.4 – Earwax Otosclerosis (387.X) –Hardening of bone tissue around the oval window Otitis media –Inflammation of the middle ear Labyrinthitis (386.3X) –Inflammation of the inner-ear labyrinth Ménière's disease (386.0X) –Excess accumulation of endolymph (fluid) in the cochlea and semicircular canals (in the inner ear) causes vertigo (dizziness)

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Ear Deafness –Conductive (389.0X) Disorder of the ossicles, tympanic membrane (eardrum), or oval window –Sensorineural (389.1X) Dysfunction involving the cochlea or acoustic nerves –Mixed hearing loss (389.2X) Involves both conductive and sensorineural deafness –Key to understanding coding: the type of deafness determines the type of hearing device used or procedure performed (e.g., cochlear implant for sensorineural; stapedectomy with incus replacement for conductive; hearing aid for conductive)