How to Document and Code for Progressive Supranuclear Palsy

by | Jan 3, 2019 | Medical Coding News, Resources | 0 comments

Progressive Supranuclear Palsy (PSP) (also called Steele-Richardson-Olszewski syndrome), is a neurological condition caused by the premature loss of nerve cells in certain parts of the brain. The long name of this disease indicates that the condition worsens (progressive) and causes weakness (palsy) by damaging certain parts of the brain above nerve cell clusters called nuclei (supranuclear). PSP affects your thinking, walking, and balance and eye movements. Affected individuals frequently experience personality changes and cognitive impairment as well. The signs and symptoms begin slowly, but can worsen over time and lead to life-threatening complications such as pneumonia and swallowing problems. There is no specific cure for this condition; however, correct and timely treatment can effectively manage or reverse the serious complications caused by PSP. Coding progressive brain disorder is a challenging process, but experienced and professional coders in reliable medical billing and coding companies can assign the right medical codes and correctly document the procedure.

Reports suggest that about 20,000 people in the United States suffer from PSP. It is estimated that this condition could affect as many as 5 in 100,000 people. The exact cause of PSP is unknown. It is a form of tauopathy, in which abnormal phosphorylation of the protein tau leads to destruction of vital protein filaments in nerve cells. The onset of this condition occurs between 45 and 75 years of age, with the average age of onset being 63 years. In most cases, males are affected more often than females.

Initial Signs and Symptoms

The type and pattern of symptoms can be quite different from one person to another. One of the first characteristic symptoms of PSP is a loss of balance while walking. Individuals may experience a tendency to fall backward or face unexplained falls or a stiffness and awkwardness in gait. In addition, people will also develop a blurring of vision and problems controlling eye movement. However, as the disease progresses additional signs and symptoms arise which include –

  • Stiffness and awkward movements
  • Falling
  • Loss of interest in pleasurable activities
  • Problems with speech and swallowing
  • Sensitivity to light
  • Sleep disturbances
  • Impulsive behavior, possibly including laughing or crying for no reason
  • Difficulties with memory, reasoning, problem-solving and decision-making
  • Depression and anxiety
  • Mild dementia
  • Surprised or frightened facial expression, (resulting from rigid facial muscles)

How to Effectively Diagnose and Treat PSP?

Diagnosing Progressive supranuclear palsy is difficult as the signs and symptoms of this condition are quite similar to those of Parkinson’s disease. Initial diagnosis is based on a thorough clinical evaluation, a detailed patient history, and a physical and neurological exam. Neurologists may recommend several diagnostic imaging tests such as MRI (to identify shrinkage at the top of the brain stem) and in some cases positron emission tomography (PET) scan to check for early signs of brain abnormalities that may not appear on MRI.

Although there is no specific cure for PSP, several treatment options are available to help ease symptoms of the disorder. Antidepressants are often recommended by physicians, along with sleeping pills to help PSP patients who are experiencing sleep problems. The most commonly used drugs are Prozac, Elavil, and Tofranil. Antiparkinsonian agents such as levodopa, or levodopa combined with anticholinergic agents may help reduce stiffness and balance problems associated with PSP. Non-drug treatment may take many forms. Onabotulinumtoxin type A (Botox), may be injected in small doses into the muscles around your eyes, which blocks the chemical signals that cause muscles to contract and eyelid spasms. Bifocals or special glasses called prisms are sometimes prescribed for PSP patients who experience the problem of looking downward. Patients who have a tendency to fall backward can use weighted walking aids. In addition, physical therapy and occupational therapy help improve balance issues. A surgical procedure called gastronomy (that involves the placement of a tube through the skin of the abdomen into the stomach for feeding purposes) will be opted as a last resort when there are swallowing disturbances.

Neurologists, pathologists and other physicians who diagnose, screen and provide treatment procedures for PSP must carefully document the same using the correct medical codes. Medical billing and coding services offered by experienced providers can help physicians use the correct codes for their medical billing purposes.

ICD-10 Code

  • G23.1 – Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski]

Living with progressive supranuclear palsy can be difficult, as affected individuals are predisposed to serious complications such as pneumonia, choking, head injury, and fractures. It can also cause changes in your brain and make conducting day-to-day activities such as walking, talking and eating extremely difficult.
Paying close attention to the specific coding guidelines can help medical coders avoid serious complexities that could arise in the process. HIPAA-compliant neurology medical coding services offered by reliable and experienced medical billing companies could help ensure accurate and timely claim filing and reimbursement.