Neurosurgery Coding Alert

Headaches are common, but other problems could signal trouble, too

Did you know that someone with an abnormal gait could have a brain tumor?

Neurosurgery coders will often have to code for patients with brain tumors. The most common symptoms are, obviously, headache and seizures. But there are also some more subtle symptoms that may be the sign of a brain tumor.

The Musella Foundation for Brain Tumor Research in Hewlett, N.Y., performed a survey of 375 brain tumor patients to learn what symptoms prompted them to seek medical care. Here is the list of most-reported symptoms:

- Headaches: Of patients surveyed, 46 percent reported having headaches. They described the headaches in many different ways, with no single pattern being a sure sign of brain tumor. Perhaps the most common thread among the headaches is that they are more severe than the patient has typically experienced. These headaches may also be accompanied by nausea and vomiting, and may get worse when the patient bends over, during sleep or when straining in the bathroom.

ICD-9 codes for this symptom include: 307.8x, 346.9x, 349.x, 784.0.

- Seizures: One-third of those surveyed reported having a seizure. -Symptoms of the condition range from sudden, violent shaking and total loss of consciousness to muscle twitching or slight shaking of a limb. Staring into space, altered vision, and difficulty in speaking are some of the other behaviors that a person may exhibit while having a seizure,- Musella Foundation's Web site says.

ICD-9 codes for this symptom include: 345.x 436, 780.3x.

- Nausea and vomiting: Just like headaches, these are non-specific symptoms because most people who experience nausea and vomiting do not have a brain tumor.
-Nausea/vomiting are more likely to point toward a brain tumor if it is accompanied by the other symptoms mentioned here,- the Musella Foundation states.

ICD-9 codes for this symptom include: 536.2, 787.01, 787.02.

- Vision or hearing problems: Many times, eye doctors will make a tumor diagnosis based on visual problems -because when they look in your eyes, they can sometimes see signs of increased intracranial pressure.- Any hearing or vision problem should be investigated to make sure no tumors are present.

ICD-9 codes for this symptom include: 368.16, 368.32, 368.8, 368.9, 369.9.

- Weakness of the arms, legs or face muscles, and strange head and hand sensations: The Musella Foundation says manifestation of these symptoms -may result in an altered gait, dropping objects, falling, or an asymmetric facial expression,- so the neurosurgeon may see patients with these symptoms. Keep in mind, however, that these could also be symptoms of a stroke.

ICD-9 codes for this symptom include: 781.0, 781.1, 781.2, 781.3, 781.7, 781.9x.

- Behavioral and cognitive problems: Many of the reported behavioral and cognitive changes included problems with recent memory, inability to concentrate, acting out, no patience or tolerance, and loss of inhibitions, according to the Musella Foundation.

ICD-9 codes for this symptom include: 312.34, 312.35, 312.9, 780.93.