MDS Alert

Hint: Aim for specificity in diagnoses to avoid, in some cases, ‘Return to Provider.’

Residents living in nursing homes may be living with movement disorders. Although Parkinson’s disease is one of the best known movement disorders, make sure you’re familiar with other diagnoses — and how to find the correct ICD-10-CM code.

There’s an entire ICD-10 code set dedicated to “Extrapyramidal and movement disorders (G20-G26).”

To get a handle on the code set as a whole, we asked Beth Schleeper, COC, CPC, CPCO, CDEO, CPB, CPMA, CPPM, CRC, CPC-I, CEMC, CANPC, CEMA, owner/ instructor of Advanced Coding Services in Phoenix, for some pointers on finding the right diagnosis code for each movement disorder.

Distinguish Parkinson’s/Secondary Parkinsonism

At the forefront of the movement disorder sequence is G20 (Parkinson’s disease). Use this for all residents suffering from Parkinson’s disease, as well as:

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

You’ll also need to know how to code secondary Parkinsonism, which you’d report with one of the following codes:

• G21.0 (Malignant neuroleptic syndrome)
• G21.1- (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)

According to Medline, National Library of Medicine, “secondary parkinsonism is when symptoms similar to Parkinson disease are caused by certain medicines, a different nervous system disorder, or another illness.

“Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease. These problems include tremors, slow movement, and stiffness of the arms and legs.”

Also: You will need to select another ICD-10 code “if there is an adverse effect, to identify the drug,” Schleeper says. Each of the secondary parkinsonism codes has its own “Use additional code” instruction, printed in red under the code listing.

Look to G24.- for Dystonia

Another movement disorder that is well-represented in G20-G26 is dystonia, which you’ll report with codes from the following range:

• G24.0- (Drug induced dystonia)
• G24.1 (Genetic torsion dystonia)
• G24.2 (Idiopathic nonfamilial dystonia)
• G24.3 (Spasmodic torticollis)
• G24.4 (Idiopathic orofacial dystonia)
• G24.5 (Blepharospasm)
• G24.8 (Other dystonia)
• G24.9 (Dystonia, unspecified)

“Dystonia is a movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements,” according to the Mayo Clinic.

Get Familiar With Other Dx Groups in G20-G26

While the aforementioned diagnoses get most of the attention in the extrapyramidal and movement disorders code set, there are a few more codes out there that round out G20-G26. Check out this rundown of those other codes:

Other degenerative diseases of basal ganglia: Report codes from the following range:

• G23.0 (Hallervorden-Spatz disease)
• G23.1 (Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski])
• G23.2 (Striatonigral degeneration)
• G23.8 (Other specified degenerative diseases of basal ganglia)
• G23.9 (Degenerative disease of basal ganglia, unspecified)

Other extrapyramidal and movement disorders: Report codes from the following range:

• G25.0 (Essential tremor)
• G25.1- (Drug-induced tremor)
• G25.2 (Other specified forms of tremor)
• G25.3 (Myoclonus)
• G25.4 (Drug-induced chorea)
• G25.5 (Other chorea)
• G25.6- (Drug induced tics and other tics of organic origin)
• G25.7- (Other and unspecified drug induced movement disorders)
• G25.8- (Other specified extrapyramidal and movement disorders)
• G25.9 (Extrapyramidal and movement disorder, unspecified)

Extrapyramidal and movement disorders in diseases classified elsewhere: Report code G26 (Extrapyramidal and movement disorders in diseases classified elsewhere).

Remember: Using the most specific diagnosis possible is important for being reimbursed for the care your team provides. For example, while a myoclonus diagnosis falls under medical management, per the Patient Driven Payment Model, “essential tremor” and “drug-induced tremor” are both categorized as “return to provider.”