Primary lateral sclerosis (PLS) is a rare, neuromuscular disorder that affects the central nervous motor neurons (also called corticospinal neurons) and causes them to slowly break down. The condition may lead to painless but progressive weakness and stiffness of the voluntary muscles that control your legs, arms and tongue. PLS occurs when nerve cells in the motor regions of the cerebral cortex (the thin layer of cells covering the brain, for high level mental functions) gradually degenerate, causing movements to be slow. In most cases, this motor neuron disease affects the legs first, followed by the body, trunk, arms and hands, and, finally the bulbar muscles (muscles that control speech, swallowing, and chewing). The condition can happen at any age, but it generally occurs for the age group of 40 – 60 years. This condition is more common in men than in women. Documenting and coding this neuro muscular disorder requires correct recording of all the prominent symptoms and treatment modalities offered. Medical coding outsourcing is an option worth considering as this can help neurologists ensure accurate and timely claim filing and reimbursement.
In primary lateral sclerosis (PLS), nerve cells in the brain, which control movement, fail over time. This in turn may cause movement problems, such as slow movements, balance problems and clumsiness. Often, PLS disorder is mistaken for another, more similar motor neuron disease called amyotrophic lateral sclerosis (ALS). However, the progression of PLS is slower than ALS and in most cases is not serious.
Signs and Symptoms of PLS
In most cases, the initial symptom of PLS is progressive muscle weakness and stiffness of the voluntary muscles of the legs. The disorder usually affects one leg and then progresses to the other. Some of the other associated symptoms include –
- Stiffness, weakness and spasticity in your legs
- Weakness and stiffness progressing to your trunk, then your arms, hands, tongue and jaw
- Hoarseness, reduced rate of speaking, slurred speech and drooling as the facial muscles weaken
- Difficulty with balance and clumsiness as the leg muscles weaken
- Difficulties with swallowing and breathing (late in the disease)
The above mentioned symptoms may at first appear in your hands or tongue and then progress down to your spinal cord to your legs. However, these symptoms usually take years to progress.
Correctly Diagnosing and Treating Primary Lateral Sclerosis (PLS)
There is no single, definitive test that correctly confirms a diagnosis of primary lateral sclerosis (PLS). As the signs and symptoms of PLS often mimic several other neurological disorders like multiple sclerosis and amyotrophic lateral sclerosis (ALS), physicians may conduct a wide range of diagnostic imaging tests to rule out the possibility of other diseases.
The initial diagnosis of this motor neuron disorder will begin with a detailed physical and neurological examination and evaluation of previous medical history. Neurologists offering treatment for this condition may conduct a wide range of diagnostic imaging tests such as – Magnetic resonance imaging (MRI), nerve conduction studies, Electromyogram (EMG), Spinal tap (lumbar puncture) and certain blood tests (to check for infections) to evaluate the symptoms and make a correct diagnosis of the condition.
Treatment modalities for this condition include – medications (such as baclofen, tizanidine (Zanaflex), clonazepam, amitriptyline and antidepressants (to reduce muscle spasms and help drooling problems), physical therapy exercises, speech therapy and assistive devices (such as a cane, walker or wheelchair) as PLS progresses.
Neurology medical coding involves the use of specific ICD-10 codes to document any such conditions, including primary lateral sclerosis (PLS). ICD-10-CM codes used to indicate a diagnosis of PLS for reimbursement purposes include –
- G12.23 – Primary lateral sclerosis
- G12.24 – Familial motor neuron disease
- G12.25 – Progressive spinal muscle atrophy
- G12.29 – Other motor neuron disease
Even though there is no cure for primary lateral sclerosis (PLS), there are several lifestyle habits that can be followed to maintain muscle function for as long as possible. Staying physically active by engaging in different kinds of exercise programs and consuming a balanced healthy diet may help avoid excessive weight gain and added pressure on your joints, thereby slowing the progression of the disease.
Medical coding for various neurological conditions can be problematical. For accurate and timely medical billing and claims submission, healthcare practices can outsource their medical coding tasks to a reliable and professional medical billing company that provides the services of AAPC-certified coding specialists.