Pediatric Coding Alert

Question: Our physician treated a patient in the observation unit of the local hospital for complications related to mixed cerebral palsy (CP). Notes indicate that the physician performed a second-day observation service, which included a problem focused interval history, an expanded problem focused exam, and moderate medical decision making (MDM). How should I report this service and diagnosis, and what exactly is mixed cerebral palsy?

Texas Subscriber

Answer: On the claim, you should report 99225 (Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity …) for the observation service.

Then, you’d append G80.8 (Other cerebral palsy) to 99225 to represent the patient’s condition.

Rationale: The code applies to mixed cerebral palsy, which may have features of spastic, athetoid, and ataxic cerebral palsies. Under the G80.8 entry in ICD-10, it states “Mixed cerebral palsy syndromes.”

According to cerebralpalsyguide.com, mixed CP “is a developmental disorder caused by brain damage that takes place before, during or shortly after birth. Those diagnosed with mixed CP have damage to the motor control centers in several parts of their brain.”

Patients with mixed CP exhibit movement problems that fall into more than one type of CP diagnosis. These patients “may have issues with movement, including: spasticity (abrupt, convulsive movements), involuntary movements, imbalance and lack of coordination,” according to the website.

The symptoms of each type of CP might appear in mixed CP patients:

• Spastic: These CP sufferers have “high muscle tone, causing stiffness and jerky movement,” cerebralpal­syguide.com states.
• Athetoid: These CP patients have “variations in high and low tone, causing rigidity and floppiness,” the website reports.
• Ataxic: These CP patients typically have “issues with balance and coordination affect normal movement,” according to the website.

Cerebralpalsyguide.com goes on to give details about this condition. “Mixed CP varies based on the location of movement problems. These movement problems can occur in the legs (diplegia), one half of the body (hemiplegia) or all four limbs (quadriplegia). The most common variation of mixed CP is a combination of spastic and athetoid symptoms.”

What about NOS code? When perusing the ICD-10 codes for CP, you might be tempted to select G80.9 (Cerebral palsy, unspecified). In the notes below this code in ICD-10, however, it states that you should use G80.9 for “Cerebral palsy NOS.” Since the provider noted mixed cerebral palsy, G80.8 is the better choice in this situation.