Health Information Management

Dangers lurk in your sleep

HIM-HIPAA Insider, April 20, 2015

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I’m always fascinated by new medical research and information about diseases I’ve never heard of. They also make great fodder for this blog.

I recently came across an article on REM sleep behavior disorder (RBD) and its link to later neurological diseases. If you suffer from RBD, you’re pretty much doomed to a disease like Parkinson’s if you live long enough. It’s also worth mentioning that if you live long enough, you’re almost assured of developing cataracts. Old age is not for wimps.
What is RBD? It’s basically moving around during REM sleep (that really, really deep sleep when you’re not supposed to be able to move). It’s not the same as sleepwalking.
Doctors think people with RBD have a brain-stem malfunction that allows them to move during REM sleep, and thus act out their dreams, according to a study published in JAMA Neurology.
On the bright side, RBD affects about 0.5% (35 million) people worldwide. (More than 7 billion people call planet Earth home, in case you were wondering.)
Does ICD-10-CM include a code for RBD? Inquiring coding minds want to know. It’s not a particularly prevalent disease, but then again, neither is mad cow and it has three ICD-10-CM codes. You do need to look up mad cow disease by its correct medical name (Creutzfeldt-Jakob disease) to find the codes, but they do exist.
Back to RBD. I started in the Alphabetic Index under disorder, sleep. I found a lot of sleep disorders, but nothing for REM sleep behavior. I also tried RBD and REM and struck out both times. Never fear, persistence pays off. In this case, I went back to disorder and looked for REM, or rapid eye movement.
REM sleep behavior turns out to be the winning term under disorder. That leads to code G47.52 under parasomnia (G47.5).
G47.5 features an Excludes1 note for:
  • Alcohol-induced parasomnia (F10.182, F10.282, F10.982)
  • Drug-induced parasomnia (F11.182, F11.282, F11.982, F13.182, F13.282, F13.982, F14.182,F14.282, F14.982, F15.182, F15.282, F15.982, F19.182, F19.282, F19.982)
  • Parasomnia not due to a substance or known physiological condition (F51.8)
In ICD-10-CM, Excludes1 means the conditions are mutually exclusive. They cannot occur in the same patient at the same time. Make sure you’re checking those notes.
I went one step further and looked into coding Parkinson’s disease in ICD-10-CM. Primary or idiopathic Parkinson’s has only one code—G20. Secondary Parkinson’s has eight. If you see a notable number of patients with Parkinson’s, take a look at the documentation. Does it tell you whether the Parkinson’s is primary or secondary for each encounter? Remember, you can’t go back to documentation from previous encounters. The provider needs to document it each time.
If the patient has secondary Parkinson’s, look for documentation of the specific type, such as:
  • Malignant neuroleptic syndrome
  • Neuroleptic induced parkinsonism
  • Vascular parkinsonism
If your physicians already document this information, great. If not, start asking for it now. Having it won’t hurt for ICD-9-CM and it may help train them for ICD-10-CM.


This article originally appeared on HCPro’s ICD-10 Trainer blog.

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