Neurology & Pain Management Coding Alert

Remember that secondary Parkinsonism is not same as Parkinson’s disease.

When a patient with Parkinson’s disease reports to the provider, coders need to have their thinking caps on when it comes time to choose a diagnosis.

Coding for Parkinson’s disease can be difficult because you must follow all of the coding notes in ICD-10, know which CPT^® codes to report for treatment, and understand the difference between Parkinson’s disease and secondary Parkinsonism.

Answer the following questions to brush up on your Parkinson’s disease knowledge.

Question 1: What is Parkinson’s disease?

Answer 1: Parkinson’s disease is a progressive disease of the nervous system. It primarily affects middle-aged and elderly people, and scientists believe it is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine.

Patients with Parkinson’s disease exhibit tremors in the extremities, jaw, and face, stiffness of the trunk, arms, and legs, swinging of arms during walking, and poor posture and balance. They move slowly, their speech and writing changes, they smile less, and they may have difficulty chewing, swallowing, and sleeping. They may become depressed and have mood changes.

Question 2: What ICD-10 code should I report for Parkinson’s disease?

Answer 2: You should report G20 (Parkinson’s disease) for Parkinson’s disease.

Other included diagnoses under G20 include the following:

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

Don’t miss: Code G20 has an Excludes1 note for G31.83 (Dementia with Parkinsonism), so report G31.83 if the provider documents dementia and Parkinsonism.

Question 3: What causes secondary Parkinsonism, and what ICD-10 codes should I report for secondary Parkinsonism?

Answer 3: Secondary Parkinsonism is similar to Parkinson’s disease; however, the symptoms are caused by certain medicines, a different nervous system disorder, or another illness.

You will turn to the following codes for secondary Parkinsonism:

• G21.0 (Malignant neuroleptic syndrome)
• G21.11 (Neuroleptic induced parkinsonism)
• G21.19 (Other drug induced secondary parkin­sonism). Note: This diagnosis also includes other medication-induced Parkinsonism.
• G21.2 (Secondary parkinsonism due to other external agents)
• G21.3 (Postencephalitic parkinsonism)
• G21.8 (Other secondary parkinsonism)
• G21.9 (Secondary parkinsonism, unspecified).

Don’t miss: Each code for secondary Parkinsonism excludes dementia with Parkinsonism (G31.83), Huntington’s disease (G10), Shy-Drager syndrome (G90.3), and syphilitic Parkinsonism (A52.19).

Important: Since several of the secondary Parkinson’s ICD-10 codes direct you to report an additional code for adverse effects or to first code the drug or external agent causing the secondary Parkinsonism, you will want to make sure you carefully read all of the notes associated with these codes.