Regarded as a chronic, progressive condition of the brain, moyamoya disease occurs when the carotid artery in the skull becomes blocked or narrowed, reducing blood flow to your brain. The term “moyamoya” describes the appearance of tiny vessels that form to compensate for the blockage. In this condition, as the normal blood vessels narrow and become blocked, it may cause a ministroke (transient ischemic attack), stroke or bleeding in the brain. It can also affect the important functions of the brain and cause cognitive and developmental delays or disability. The brain tries to compensate for the reduced blood flow by growing new blood vessels called “collaterals”. Even though these blood vessels can temporarily help increase blood supply, they eventually stop working. There are currently no medications that can stop or reverse the progression of this condition. Treatment involves managing symptoms with medicine or surgery. The treatment also focuses on reducing the risk of stroke and restoring blood flow to the brain. Once the process of blockage (vascular occlusion) begins, it tends to continue and a major stroke or bleeding could occur resulting in permanent loss of function. It is important to treat this condition promptly. Neurologists, neurosurgeons and other specialists who treat this progressive condition of the brain need to correctly document the same in the patient’s medical records. Opting for medical billing services from an established medical billing company can help simplify the documentation process.
Generally, moyamoya disease affects children; however, adults may also experience this condition. It is slightly more common in children of Asian descent than in other ethnic backgrounds. This disease is most prevalent in Japan, but has also been diagnosed among people throughout the world. In the United States, the risk of developing this condition is less than 1 in 100,000. It can occur at any time, but is most commonly diagnosed in children aged between 5-15 years and in adults in their early 40s. Females have a higher risk of developing this condition.
Identifying the Causes and Symptoms
The exact cause of this condition is unknown. Reports suggest that about seven percent of children with moyamoya are believed to have an inherited gene defect. However, in at least half of all known cases of moyamoya, the disease has no identifiable cause. The condition is often associated with other disorders like neurofibromatosis type 1, sickle cell disease and Down syndrome and hyperthyroidism. The complications that occur as part of the disease are associated with the effects of stroke, such as – movement disorders, vision problems and learning or developmental issues.
One of the initial symptoms of moyamoya disease usually appears with a stroke or recurrent transient ischemic attack (TIA), especially in children. During a TIA, a blockage interrupts the flow of oxygen-carrying blood to the brain. Other related symptoms include: –
- Visual disturbances
- Progressive difficulty in thinking and remembering due to repeated strokes and bleeding
- Involuntary movements
- Hemiparesis (Weakness, numbness or paralysis in the face, arm or leg, typically on one side of the body)
- Difficulties with speaking or understanding others (aphasia)
- Developmental delays
The above symptoms can be triggered by exercise, crying, coughing, straining or fever.
How Is Diagnosis of Moyamoya Disease Made?
If a person experiences stroke-like symptoms, he/she may be referred to a neurosurgeon. Before beginning the diagnosis, the surgeon will review the patient symptoms, current and previous medical problems, medications taken and medical history. A detailed physical examination will be performed. Several diagnostic tests may be necessary to analyze the symptoms and other underlying conditions. Common diagnostic imaging tests include – Magnetic resonance imaging (MRI), Computerized tomography (CT) scan, Transcranial Doppler ultrasound, Electroencephalogram (EEG), cerebral angiogram and Positron emission tomography (PET) scan or single-photon emission computerized tomography (SPECT). These imaging tests are performed to correctly detect the nature of arterial narrowing and collateral blood vessels of moyamoya that have the appearance of a “puff of smoke.” Imaging studies can also reveal evidence of multiple small strokes.
By performing these tests, physicians will evaluate the patient’s condition and determine the most appropriate treatment. Treatment modalities may primarily focus on reducing the impact of symptoms, improve blood flow, and reduce the risk of other serious complications such as an ischemic stroke (caused by a lack of blood flow, bleeding in your brain (intracerebral hemorrhages) or death. Treatment modalities comprise medications (like blood thinners, calcium channel blockers and anti-seizure medications) that help reduce the risk of stroke or help in seizure control. However, if the symptoms become worse or if any tests show evidence of low blood flow, physicians may recommend revascularization surgery. In this surgical procedure, surgeons bypass blocked arteries to help restore blood flow to your brain. They may use direct or indirect revascularization procedures, or a combination of both the procedures. In order to address the physical and mental effects of this condition, physicians may recommend other therapies like physical and occupational therapy. Cognitive behavioral therapy may also be prescribed to address emotional issues related to having moyamoya disease and ways to coping with the fears and uncertainties about future stroke.
Neurologists, Neurosurgeons or other physicians who diagnose, screen and treat moyamoya disease must carefully document these tests and procedures using the correct medical codes. Billing and coding services offered by established medical billing and coding companies can help physicians in using the correct codes for their medical billing process. In ICD-10, code 167 and its complete sub-categories offer more specific representation of the other cerebrovascular diseases –
The prognosis for patients with moyamoya is quite complex to predict. The condition can progress slowly with occasional TIAs or strokes, or it can involve rapid decline. The overall prognosis for patients with this condition is based on the extent of vascular blockage and the patient’s ability to develop effective collateral circulation, the age of the patient at onset of symptoms, and the severity of disability resulting from a stroke. The patient’s neurologic condition at the time of treatment is an important factor in determining the long-term outcome of the disease.
Billing and coding for cerebrovascular disorders is challenging. Outsourced medical billing services can help physicians ensure the correct medical codes on their claims, and optimal reimbursement.
Foot and ankle injuries usually occur during sport participation, but can also occur when the foot or ankle is forced into an awkward position when walking or performing other everyday activities. Achilles tendon rupture, ankle fracture, and Lisfranc injury are three types of painful foot and ankle injuries that medical coding service providers help physicians report to payers. Applying the right ICD-10 codes based on the documentation is critical to create and submit claims for appropriate reimbursement.
Achilles Tendon Rupture
An acute rupture of the Achilles tendon is amongst the common tendon injuries in the US adults. Symptoms include a feeling of a sudden snap at the back of the leg, intense pain and swelling near the heel, and inability to climb stairs, run, or stand on the toes. However, as patients can present without any signs or symptoms, cases may be initially misdiagnosed. The Thompson test which involves squeezing the calf with the patient prone and the knee on the affected side flexed can help diagnose the condition. Pulses and sensation in the foot may be also checked. X-rays, ultrasound, and MRI may be used if the diagnosis remains uncertain after the physical examination.
The ICD-10 codes for Achilles tendon rupture are:
M76.6 Achilles tendinitis
- M76.60 Achilles tendinitis, unspecified leg
- M76.61 Achilles tendinitis, right leg
- M76.62 Achilles tendinitis, left leg
There are two options for the management of Achilles tendon rupture: surgical repair and nonoperative treatment which involves referral to a functional rehabilitation program. Surgery may be the better alternative as it will reduce the risk of repeat rupture. Nevertheless, treatment recommended will depend on the patient’s condition, underlying medical concerns if any, the extent of the injury and the future activity expectations.
The ankle joint, the region where the leg and foot meet, consists of three articulations: the talocrural joint, the tibiofibular joint, and the subtalar joint. The ankle joint allows the upward and downward movement of the foot. An ankle fracture involves one or more bones in the joint and is an extremely painful condition. Appropriate diagnosis and timely intervention are necessary to prevent long-term complications and debility.
Typical symptoms of a broken ankle include difficulty or inability to support weight, tenderness or pain, swelling which increases with the severity of the swelling, and discoloration of the skin which is usually due to bruising.
Ankle fractures have symptoms similar to sprains. X-rays can identify a broken bone or bones and distinguish the injury from a sprain, which is a soft-tissue injury. A CT scan or MRI may be needed to determine the full extent of the injury.
Diagnosis of ankle fracture is reported using the following ICD-10 codes:
S82.84 Bimalleolar fracture of lower leg
- S82.841 – Displaced bimalleolar fracture of right lower leg
- S82.842 – Displaced bimalleolar fracture of left lower leg
- S82.843 – Displaced bimalleolar fracture of unspecified lower leg
- S82.844 – Nondisplaced bimalleolar fracture of right lower leg
- S82.845 – Nondisplaced bimalleolar fracture of left lower leg
- S82.846 – Nondisplaced bimalleolar fracture of unspecified lower leg
- S82.851 – Displaced trimalleolar fracture of right lower leg
- S82.852 – Displaced trimalleolar fracture of left lower leg
- S82.853 – Displaced trimalleolar fracture of unspecified lower leg
- S82.854 – Nondisplaced trimalleolar fracture of right lower leg
- S82.855 – Nondisplaced trimalleolar fracture of left lower leg
- S82.856 – Nondisplaced trimalleolar fracture of unspecified lower leg
The Weber ankle fracture classification categorizes the injury into three types, A, B and C, based on the level of the fracture. Ankle stabilization bracing without immobilization is used to manage Type A fractures. Six weeks of immobilization in a walking boot is recommended for nondisplaced type B and C fractures, which need to be followed up closely until bony union is achieved. Surgery may be required to if the bone does not align properly after 3 months.
The Lisfranc joint is the point at which the metatarsal bones and the tarsal bones connect.Lisfranc injury consists of a variety of midfoot injuries in which one or more metatarsals are displaced from the tarsus. Lisfranc injuries include sprains, fractures and dislocations, which can sometimes occur simultaneously.
Lisfranc injury is typically caused by a direct blow to the midfoot which can occur in high energy motor vehicle accidents (MVA), industrial accidents, crush injury, falls from heights, and sports participation. Lisfranc injury is difficult to identify and diagnosis is missed on initial assessment in 20% of cases, according to an MDedge article.
Symptoms may include swelling of the foot, pain in the midfoot when standing or when pressure is applied, inability to bear weight, bruising or blistering on the arch or/and top of the foot, and abnormal widening of the foot.
Lisfranc injuries can be confused with ankle sprains. In addition to a physical exam, X-rays and other imaging studies may be performed to understand the extent of the injury and arrive at the diagnosis.
The ICD-10 codes for LisFranc injury are:
- S93.324 – Dislocation of tarsometatarsal joint of right foot,
- S93.325 – Dislocation of tarsometatarsal joint of left foot
- S93.326 – Dislocation of tarsometatarsal joint of unspecified foot
Management of Lisfranc injury depends on the stability of the joint complex and severity of the injury. Stable injury without fracture can be managed with immobilization in cast for two weeks and use of crutches to avoid putting pressure on the injured foot. If tenderness improves this can be followed by weight-bearing as tolerated in the boot. If pressure builds up within the tissues of the foot, a complication of Lisfranc injury, it can damage the nerves, blood vessels and muscles in the foot. In this case, surgery would be required to prevent tissue damage.
There are specific ICD-10 codes to report foot and ankle injuries. Outsourced medical billing services provided by experienced companies can help physicians assign the correct codes and submit accurate claims for optimal reimbursement.
New Year’s celebrations are among the most fun parties of the year and include noisy parties, parades, fire crackers, family meals, shopping, dancing, and much more. The holidays also often are cause for celebrations involving alcohol consumption, a major contributing factor to motor vehicle crashes. As people gear up for celebrations to ring in 2020, emergency departments and healthcare providers need to be ready to face unusual patient care incidents. Additionally, they have to be knowledgeable about the medical codes to report for any treatment provided. Outsourced medical billing services are available to help physicians submit accurate claims with the right codes for optimal reimbursement.
Here are the 8 ICD-10 Codes for the New Year
Selecting the appropriate ICD-10 codes is an important part of correctly capturing patient care and ensuring proper reimbursement, which is possible with expert physician billing services.
According to the United States Consumer Product Safety Commission, most holiday injuries are caused by common festive and fun holiday activities. To avoid injuries, make sure to light your fireworks one at a time from a safe position, wear protective goggles while using fireworks, never drive drunk, and follow safety rules to avoid accidents while walking.
Chondromalacia patella is a condition where in the cartilage on the under surface of the patella (kneecap) deteriorates and softens. Outsourced medical billing services are a practical option when it comes to accurate and timely claim filing for appropriate reimbursement. Treatment for this knee condition is aimed at reducing the pressure on the kneecap and joint.
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