This month, “In the kNOW” will be covering the topic of Parkinson’s disease. With the recent FY2024 ICD-10-CM code update that impacted coding for Parkinson’s, now is a good time to review this condition.
Let’s start with some information about Parkinson’s disease. It is a progressive, neurological disorder which affects the basal ganglia of the brain. Neurons that produce a chemical neurotransmitter called dopamine die or become damaged. The loss of dopamine production is what produces tremors, the classic symptom of Parkinson’s. Other symptoms include rigidity, stiffness, and bradykinesia. As the disease progresses, other symptoms such as depression and dementia may occur.
Parkinson’s disease is the second most common age-related degenerative brain decease behind Alzheimer’s. It is also the most common motor brain disease. The disease usually presents around age 60 but can occur earlier such as with Michael J. Fox who was diagnosed with Parkinson’s at age 29.
While Parkinson’s disease is not curable, the symptoms can be managed with medication. Three of the most common medications prescribed for patients with Parkinson’s are:
Levodopa-a medication that increases dopamine levels in the brain
Carbidopa-a medication administered in conjunction with Levodopa to prevent conversion of the Levodopa into dopamine outside of the brain
Sinemet-a combination of Levodopa and Carbidopa
Over time, as the disease progresses, the effects achieved with Levodopa can lessen due to waxing and waning. Symptoms, both motor and nonmotor, may become more prevalent during the “OFF” phases even while taking the medication. Dyskinesia may also develop if higher dosages of Levodopa are taken.
With the new Parkinson’s codes for FY2024 shown below, coding professionals are able to report OFF episodes (fluctuations) and dyskinesia if appropriate.
G20.A1 Parkinson's disease without dyskinesia, without mention of fluctuations
Parkinson's disease NOS
Parkinson's disease without
dyskinesia, without mention of OFF episodes
G20.A2 Parkinson's disease without dyskinesia, with fluctuations
Parkinson's disease without dyskinesia, with OFF episodes
G20.B1 Parkinson's disease with dyskinesia, without mention of fluctuations
Parkinson's disease with dyskinesia, without mention of OFF episodes
G20.B2 Parkinson's disease with dyskinesia, with fluctuations
Parkinson's disease with dyskinesia, with OFF episodes
G20.C Parkinsonism, unspecified
Parkinsonism, NOS
Excludes1: Parkinson's disease NOS (G20.A1)
Parkinson's disease with dyskinesia (G20.B-)
Parkinson's disease without dyskinesia (G20.A-)
Secondary parkinsonism (G21-)
Two of the subcategories for Parkinson’s capture the disease with or without dyskinesia and fluctuations. The third subcategory is for Parkinsonism at G20.C. Parkinsonism is an umbrella term that covers not only Parkinson’s disease but other conditions that have similar symptoms. Examples include corticobasal ganglionic degeneration, Wilson disease, some toxins such as manganese, and some medications such as metoclopramide.
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About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP, is an HIM professional with over 25 years of experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA, along with being an AHIMA-approved ICD-10-CM/PCS trainer. Dianna has held many positions in HIM and is now an independent coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna is an AHIMA-published author and has volunteered with AHIMA on projects including certification item writing, certification exam development, coding rapid design, and most recently has served on AHIMA’s nominating committee. She is a presenter on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
