Neurology & Pain Management Coding Alert

Question: Which diagnosis should I report for a rubral tremor?

New Mexico Subscriber

Answer: Your best option is probably 333.1 (Essential and other specified forms of tremor).

This condition -- also known as Holmes- tremor -- includes a combination of rest, postural and action tremors due to midbrain lesions in the vicinity of the red nucleus. Rubral tremors are irregular and slow-frequency (4.5 Hz). The patient might show signs of ataxia and weakness. The tremor is often most prominent when the patient is active or when he maintains a particular posture.

Common causes include cerebrovascular accident and multiple sclerosis, with tremor onset and lesion occurrence possibly delaying for two weeks to two years.