Health Information Management

Temporal sclerosis

JustCoding News: Inpatient, November 11, 2009

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Temporal sclerosis

Temporal sclerosis is the loss of neurons and scarring of the deepest portion of the temporal lobe. It is associated with brain damage caused by the following:

  • Traumatic brain injuries
  • Infections
  • Brain tumors
  • Lack of oxygen to the brain
  • Uncontrolled seizures

Scar tissue forms as the brain heals from injury on the hippocampus, which is the part of the temporal lobe responsible for learning and memory. The region begins to atrophy, neurons die, and scar tissue forms. Temporal sclerosis can occur on either one or both sides of the brain.

Symptoms
Seizures caused by temporal sclerosis can manifest in a variety of symptoms, including:

  • Strange sensations
  • Changes in behavior or emotions
  • Muscle spasms
  • Convulsions

The seizures are usually localized in the brain, but they may spread and become generalized seizures (involving the entire brain) and may cause a sudden loss of awareness or consciousness.

Physicians can diagnose temporal sclerosis using a radiology procedure known as a magnetic resonance imaging (MRI) scan. A physician will assess the extent of the temporal sclerosis to determine the patient’s prognosis.

Treatment
Generally, physicians treat temporal sclerosis by performing a temporal lobectomy, which involves excising the portion of the brain where the seizures start. Patients with unilateral temporal sclerosis have the best outcome, reflected by the elimination of seizure activity and a low significance of new neurological impairments.

ICD-9-CM code
The new ICD-9-CM code 348.81 (Temporal sclerosis) took effect October 1, 2009.

ICD-9-CM procedure codes

  • 01.53 (Lobectomy of brain)
  • 01.59 (Other excision or destruction of lesion or tissue of brain)

Select the appropriate code based on whether the physician removes the whole lobe or just a portion of it.

CPT codes
For professional services, report one of the following CPT codes:

  • 61537 (Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, without electrocorticography during surgery)
  • 61538 (Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, with electrocorticography)



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