Parkinson’s Disease

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.

Now you are In the kNOW!!

 
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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.

OHIMA Opposes AHIMA Recertification Update

January 2024 Update: Consider signing the PETITION opposing 40% requirement!   AHIMA is rolling out a series of updates to the Recertification Guidelines. The changes include new ways to earn CEUs, a CEU rollover advantage, and a requirement that a minimum of 40% of CEUs must come directly from AHIMA resources. The Component Associations (i.e. state associations including OHIMA) and its three regional/local associations (Northwest, Northeast, and Southwest Ohio HIM Associations) are not included in this 40%. 40% of CEUs must come directly from AHIMA. The remaining 60% of CEUs can come from component associations and other third-party education providers. Please visit AHIMA’s dedicated Recertification webpage to learn more about the change and/or download the AHIMA Recertification Policy FAQ.   OHIMA and other state associations have received many concerns from credentialed health information professionals regarding this change. The concerns are of such a magnitude that OHIMA joined forces with twenty-seven other CAs to submit a written letter to AHIMA. This letter voiced our opposition to the new requirement that 40% of CEUs must come directly from AHIMA as it does not include the partnering Component Associations and other AHIMA ACEP (Approved Continuing Education Program) providers. It will also significantly impact the fiscal viability of OHIMA to provide local and affordable education and networking – which is part of our mission as a state component association. This letter was submitted to AHIMA on November 29, 2023. Several other CAs have since signed on to the letter.   Read the Letter from CAs   AHIMA responded to our letter on December 14, 2023 stating that, after carefully considering the feedback received, CCHIIM voted to defer implementation of the 40% AHIMA CEU requirement until no earlier than January 1, 2025. Per AHIMA, this "decision was made to give certificate holders ample time to understand the changes and plan accordingly. Over the next several months [AHIMA] will provide additional information and support to ensure they’re prepared once this change goes into effect. The 2024 Recertification Guide will be available on the AHIMA website by no later than December 22. Please refer to the guide for additional information regarding all changes." Read AHIMA's Full Response   The OHIMA Board will continue to represent our members and all AHIMA credentialed health information professionals in opposing this change because separating the component associations from AHIMA in this requirement removes the members’ choice in where they obtain continuing education to meet their recertification needs.   If you, as a member of AHIMA and OHIMA, would like to voice your opposition to this change – a template has been provided below (in Word so it can be customized) to contact AHIMA.   Member Letter Template   Stay tuned for additional information regarding this situation. Feel free to reach out to OHIMA's Senior Executive Director, Lauren Manson, RHIA, CAE at ohima@ohima.org should have you have questions.