Neurology & Pain Management Coding Alert

Don't let dysdiadochokinesia slow up your coding.

In order to decipher your neurologist's notes for proper coding, it's important to understand the various medical terms he might use in his documentation.

Dysmetria:

Dysmetria is an inability or impaired ability to accurately control the range of movement in muscular acts.

Dysmetria results in overshooting or undershooting of a target while attempting to reach an object and is often tested by asking the patient to extend her index finger and touch her nose, says Neil A. Busis, MD, FAAN, chief of the division of neurology at Shadyside Hospital in Pittsburgh, Penn. The patient will then touch the neurologist's outstretched finger with the same finger. The patient goes back and forth between touching her nose and the physician's finger. Once this is done correctly a few times at a moderate cadence, the patient will continue with her eyes closed. Normally this movement remains accurate when the eyes are closed.

Dysdiadochokinesia:

Dysdiadochokinesia means "an inability to perform rapidly alternating movements, such as rhythmically tapping the fingers on the knee."

In testing for dysdiadochokinesia, your neurologist will likely ask the patient to place her hands on her thighs and then rapidly turn her hands over and lift them off her thighs. Once the patient understands this movement, the neurologist will have the patient repeat it rapidly for 10 seconds. Normally, this is possible without difficulty. This is considered a rapidly alternating movement and also included as an example in the "test coordination" bullet in the Neurological specialty physical exam for the 1997 E/M documentation guidelines.

Note: In ICD-9 both dysmetria and dysdiadochokinesia are reported under 781.3 (Lack of coordination).