Many studies have reported that people infected with COVID-19 may also experience neurological symptoms and these complications may occur with or without cardiovascular and respiratory symptoms. Neurological Research and Practice has discussed certain neurological manifestations related to SARS-CoV-2 infection such as encephalopathy and encephalomyelitis, ischemic stroke and intracerebral hemorrhage, anosmia, different types of Guillain-Barré syndrome (GBS) and neuromuscular diseases. Neurology medical billing companies can help specialists providing treatments for such disorders to submit error-free claims. Specific neurological symptoms accompanying the COVID-19 infection include loss of smell and taste, muscle weakness and pain, tingling in the hands and feet, ischemic and hemorrhagic stroke, and seizures.

ICD-10 Codes to Report Neurological Complications Related to COVID-19

Guillain-Barré syndrome (GBS) (acute inflammatory demyelinating polyneuritis – AIDP)

Guillain-Barré syndrome (GBS) is a serious complication of COVID-19 disease and can occur within days of the first respiratory symptoms. The neurological symptoms usually appear within 5–10 days after a COVID-19 diagnosis, although GBS may develop even weeks after infection. The symptoms range from mild sensitive deficits to severe tetraparesis. Severe conditions may often lead to respiratory insufficiency and need of ventilation.

  • G61 Inflammatory polyneuropathy
    • G61.0 Guillain-Barre syndrome
    • G61.1 Serum neuropathy
    • G61.8 Other inflammatory polyneuropathies
    • G61.82 Multifocal motor neuropathy
    • G61.89 Other inflammatory polyneuropathies
    • G61.9 Inflammatory polyneuropathy, unspecified
  • G62 Other and unspecified polyneuropathies

Acute Disseminated Encephalomyelitis (ADEM)

ADEM occurs as a rare complication following this infection. The clinical symptoms of ADEM vary significantly. MRI or CSF testing will be recommended to diagnose ADEM. Treatment may include administration of high-dose corticosteroids and administration of immunoglobulins (in case of an insufficient response to steroids).

  • G04 Encephalitis, myelitis and encephalomyelitis
    • G04.0 Acute disseminated encephalitis and encephalomyelitis (ADEM)
    • G04.00 Acute disseminated encephalitis and encephalomyelitis, unspecified
    • G04.01 Postinfectious acute disseminated encephalitis and encephalomyelitis (postinfectious ADEM)
    • G04.02 Postimmunization acute disseminated encephalitis, myelitis and encephalomyelitis

Acute Encephalopathy and Encephalitis

Encephalopathy is a diffuse brain dysfunction without structural or direct infectious cause. Systemic infections can trigger septic encephalopathy in case of multi-organ failure or other types of metabolic encephalopathy. Acute encephalitis may be caused by the direct infection of brain tissue with the virus.

According to a report from Neurological Research and Practice, COVID-19 cases with symptoms suggestive of encephalitis are olfactory and gustatory disturbances, headaches, dizziness, hallucinations, confusion, dysexecutive disorders, agitation, vigilance reduction, neuralgia, epileptic seizures, ataxia, sudden neurological deficits or pyramidal tract signs. Diagnosis may require CT or MRI to detect structural lesions and brain edema and EEG to monitor diffuse brain dysfunction and for the detection of pileptic seizures or status epilepticus. Treatment may involve symptomatic neuroleptic or thymoleptic therapy.

  • G93.3 Post viral fatigue syndrome
    • G93.4 Other and unspecified encephalopathy
    • G93.40 Encephalopathy, unspecified
    • G93.41 Metabolic encephalopathy
    • G93.49 Other encephalopathy

Cerebrovascular Diseases

SARS-CoV-2 infection may be associated with an increased incidence of cerebrovascular diseases such as ischemic stroke and intracerebral hemorrhage. The rate of cerebrovascular events was higher in patients with severe respiratory events and patients with a history of cerebrovascular disease have a higher risk for a more severe course of COVID-19 disease.

Ischemic strokes and rarely intracerebral hemorrhage (ICH) occur in patients with COVID-19 disease and are associated with a more severe course of the disease. In a study published in Springer Link, it has been reported that Intracerebral hemorrhage was detected in every tenth patient with acute respiratory distress syndrome (ARDS), due to COVID-19 compared to other causes of ARDS. When treating COVID-19 patients, physicians detect possible cerebrovascular complications and immediately initiate the necessary diagnostic procedures. CT or MRI is performed to detect clinical signs and symptoms of stroke.

  • I63 Cerebral infarction
    • I63.0 Cerebral infarction due to thrombosis of precerebral arteries
      • I63.00 Cerebral infarction due to thrombosis of unspecified precerebral artery
    • I63.01 Cerebral infarction due to thrombosis of vertebral artery
      • I63.011 Cerebral infarction due to thrombosis of right vertebral artery
      • I63.012 Cerebral infarction due to thrombosis of left vertebral artery
      • I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries
      • I63.019 Cerebral infarction due to thrombosis of unspecified vertebral artery
    • I63.02 Cerebral infarction due to thrombosis of basilar artery
    • I63.03 Cerebral infarction due to thrombosis of carotid artery
      • I63.031 Cerebral infarction due to thrombosis of right carotid artery
      • I63.032 Cerebral infarction due to thrombosis of left carotid artery
      • I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
      • I63.039 Cerebral infarction due to thrombosis of unspecified carotid artery
    • I63.09 Cerebral infarction due to thrombosis of other precerebral artery
    • I61 Nontraumatic intracerebral hemorrhage
      • I61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcortical
      • I61.1 Nontraumatic intracerebral hemorrhage in hemisphere, cortical
      • I61.2 Nontraumatic intracerebral hemorrhage in hemisphere, unspecified
      • I61.3 Nontraumatic intracerebral hemorrhage in brain stem
      • I61.4 Nontraumatic intracerebral hemorrhage in cerebellum
      • I61.5 Nontraumatic intracerebral hemorrhage, intraventricular
      • I61.6 Nontraumatic intracerebral hemorrhage, multiple localized
      • I61.8 Other nontraumatic intracerebral hemorrhage
      • I61.9 Nontraumatic intracerebral hemorrhage, unspecified

Seizures and Epilepsy

COVID-19 virus can also cause complicated disorders in the nervous system, such as seizures and epilepsy. Epilepsy is one of the most common, sudden, and recurrent neurological disorders, affecting about 50 million people worldwide. Secondary seizures may be initiated after strokes, electrolyte imbalance, increased oxidative stress, and mitochondrial dysfunction in Covid-19 patients. Diagnosis may be done using EEG to detect epileptogenic lesions and signs of increased intracranial pressure and the treatment may include antiepileptic therapy for acute symptomatic seizures and status epilepticus.

  • G40 Epilepsy and recurrent seizures
    • G40.0 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset
      • G40.00 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable
      • G40.01 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable
    • G40.1 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures
      • G40.10 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable
      • G40.11 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable
    • G40.2 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures
      • G40.20 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable
      • G40.21 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable
    • G40.3 Generalized idiopathic epilepsy and epileptic syndromes
      • G40.30 Generalized idiopathic epilepsy and epileptic syndromes, not intractable
      • G40.31 Generalized idiopathic epilepsy and epileptic syndromes, intractable

Not only for neurology, SARS-CoV-2 pandemic has implications for all areas of medicine. While busy providing quality care for patients, healthcare providers can rely on an experienced physician billing company to take care of tasks such as insurance eligibility verification and medical coding that impacts the revenue growth of their practice.