Geriatric Medical Coding - Coding for Dementia

Geriatric medicine involves health concerns of the elderly population, and these cover a number of syndromes and conditions. Dementia, urinary incontinence, osteoarthritis, diabetes, cardiovascular diseases, cerebrovascular diseases, hypertension, hearing concerns, and hyperthyroidism are some of the major conditions. Geriatricians carry out various examinations and offer counseling sessions for their patients. Practitioners in this field also screen patients for various psychosocial concerns.

Dementia Codes - Medical and Psychiatric Codes

Dementia is a condition that affects a number of old people and it is defined as the progressive and severe impairment of one's brain function that interferes with one's normal functioning. Dementia is usually irreversible. It may be mild, moderate, severe or profound.

The new codes for dementia are provided in ICD-10 Chapter V: Mental and Behavioural Disorders. These codes signify various types of dementia and include medical codes and psychiatric codes. When billing for dementia, service providers should give the correct diagnostic codes for medical conditions causing irreversible dementia such as:

• Alzheimer's disease

• Frontotemporal dementia

• Multi-infarct dementia

• Parkinson's disease with dementia

• Huntington's disease

• Leukoencephalopathies

• Senile degeneration of the brain

• Mild cognitive impairment

• Dementia with Lewy bodies

• Pick's disease

• Binswanger's disease

• Creutzfeldt-Jakob disease

• Multiple sclerosis

• HIV

• Neurosyphilis

• Unspecified cerebral degeneration

• Memory loss and late effects of CVD

Psychiatric codes signify uncomplicated senile dementia, presenile dementia, senile dementia with delusional features, senile dementia with depressive features, senile dementia with delirium, arteriosclerotic dementia, dementia without behavioral disturbances, and dementia with behavioral disturbances. When coding, it is necessary to indicate whether the dementia occurred with or without behavioral disturbances such as violent behavior, aggressive behavior, wandering off and more.

Reversible types of dementia are treatable and are most often caused by conditions such as brain tumors, chronic alcoholism, infections, certain deficiencies, heavy-metal poisoning, hyperthyroidism and so on. Providers can bill for pharmacologic, physical, occupational, speech-language and other therapies that are provided for their dementia patients. Payers require that providers clearly enter their primary diagnosis as well as the secondary diagnosis that support the medical necessity of the services provided. In case the patient suffers from an illness or injury not related to their dementia, the physician's primary diagnosis recorded in the claim should reflect clearly the need for the billed service.

Factors that Have an Impact on Reimbursement

• CMS does not regard certain diagnostic codes as regular medical codes. As a result, these are not reimbursed at the usual rate, sometimes these are not paid at all. The provider has to have in-depth knowledge regarding the assignment of the correct primary and secondary diagnostic codes to ensure full reimbursement.

• Reporting all professional services in all settings such as inpatient, outpatient, home and nursing facilities, correctly using the appropriate CPT five digit codes

• Appropriate use of evaluation and management (E/M) codes or the five digit codes used to report non-procedural professional services. These codes should clearly highlight the complexity of the service provided. Tests such as gait and balance assessment, mini mental status exam, history, physical and family interview do not have their own CPT codes. So these are included under E/M.

A physician's interaction with the patient includes screening, procedure visit and visit for discussing results. For effective reimbursement, the correct diagnostic and procedural codes have to be assigned for each of these visits. During screening, the physician identifies the condition for which the appropriate diagnostic code has to be assigned. Any new problem that requires a differential diagnosis has to be documented during the procedure visit. The provider has to also ascertain whether requirements for a higher level code are met. Additional documentation includes valid diagnostic codes to justify a comprehensive exam, codes to report any co-existing conditions such as diabetes, weight loss, delirium and so on. This is important with regard to using higher levels of E/M coding. In the case of a patient with multiple problems, the doctor will have to spend more time to complete the assessment. It is the visit's complexity that would justify billing for the highest level E/M.

• 99205 - Level 5 comprehensive exam for new patient

• 99215 - Level 5 comprehensive exam for established patient

• 96116 - neurobehavioral status examination

Codes to Use for Care Management Provided

• First hour - 99358

• Each additional 30 minutes - 99359

• Telephone services - 99371-3

Tips for Accurate Coding

Review of systems (ROS), history of present illness (HPI), family, physical examination, social medical history, medical decision making, time spent for discussion of counseling, and organizing care, all these have to be taken into account when assigning E/M codes. When coding for dementia, under no circumstances should a lower level of service be reported using a higher level code. If you are to receive due reimbursement, medical necessity of a provided service is of course the primary consideration. Individual requirements of the CPT codes used are also a major criterion. The level of service reported should have sufficient supporting documentation.

How to Diagnose and Relieve a Candida Albicans Intestinal Yeast Infection

A Candida Albicans intestinal yeast infection is caused by a fungal organism which, it is believed, is present in everybody's gastrointestinal (GI) tract no matter what their age, how healthy they are or their gender.

Candida Albicans is the most common type of candida fungus/ mold, and all healthy people are immune to candida albicans. In fact, for many years a solution containing candida albicans has been injected just under the skin as a way of checking for a normal healthy immune response or for any obvious abnormalities.

The most common types of Candida Albicans are those which cause either a vaginal yeast infection in women or oral thrush which can infect anyone including young babies.

In a normal healthy host, candida present in the gut is kept under control by both the body's immune system and the friendly bacteria (probiotics) that are found in the intestinal tract.

However, problems start to occur when the Candida Albicans is allowed to colonize, multiplying and causing many of the symptoms associated with a candida infection, which range from stomach irritation to more severe even life threatening symptoms.

This can happen due to a number of reasons:

The levels of friendly bacteria in the GI tract have been reduced below a healthy amount often due to taking prescribed or non-prescribed medication for an extended period of time. This then compromises the body's natural ability to keep the candida albicans from multiplying. If a person has been taking a long course of antibiotics then it is worth keeping a close watch for any yeast infections.

A poor immune system, either through medication or through illness, can allow the candida albicans to thrive and spread. Candida infections are not unusual in HIV patients or in people who have been treated with Chemotherapy. Also a persons lifestyle can impact on their immune system, especially if they have stressful jobs or ongoing stressful personal situations.

Also, a poor diet has been attributed to an increased risk of a candida infection. This is particularly true of diets that are high in sugar.

Unfortunately as it grows the Candida Albicans can change from its relatively harmless "yeast" form, into the fungal form, which lines the GI tract walls and, if allowed to overgrow, uses its long root like tentacles to penetrate the intestinal lining and release spores into the rest of the body.

If this occurs, then a break down may occur between a person's intestinal tract and their circulatory system and so allow the introduction of allergens, poisons, irritants and toxins into the bloodstream. If the openings are large enough then partially digested proteins may also enter the bloodstream, a situation known as leaky gut syndrome.

Although it has been hard to diagnose in the past, as candida is a normal part of the GI tract flora, there have been some advances. A simple blood test known as a Candida Albicans Assay test can often be enough to diagnose whether a person has an increased level of Candida antibodies in their bloodstream.

To help a diagnosis ensure that you keep a record of any symptoms you may be suffering from and discuss them with your medical practitioner. There are a number of conditions that can have similar symptoms to a candida overgrowth, so the more you know about the condition the better chance you have of fighting it.

Treatments have been shown to be effective against candida albicans infections once it has been successfully diagnosed, and they usually include a course of anti -fungal medication, a change in lifestyle to reduce stress and an anti-candida diet.

To reduce the risk of another Candida albicans intestinal yeast infection occurring, it is important to understand the initial cause of the infection and treat that to reduce the chance of further episodes.

MS Numbness on the Left Side - What Causes It?

Of all the different symptoms of multiple sclerosis, some form of numbness or tingling sensation in at least one extremity is one of the most common. MS numbness on the left side is the symptom that seems to be the most prevalent even though the numbness can actually occur in any of your extremities. This disease affects the central nervous system by virtue of the growth of plaque that causes damage to the myelin sheath that protects the nerves in the spinal cord.

What Causes MS Numbness on the Left Side?

Multiple sclerosis is a degenerative disease of the nervous system, over time lesions will grow in various locations along the spinal cord and around the brain. Each of these lesions will cause delamination of the myelin sheath that protects the nerves that are inside the spinal cord. This damage affects the way that signals are processed and sent to the brain.

One of the symptoms of ms is numbness on the left side of the body. These symptoms along with numbness that can occur in your fingers, toes or other limbs will most likely show up in the early stages of the disease, however the vast majority of all patients will experience some level of numbness during their lives as the damage to their nervous system continues to increase.

Treatments for MS Numbness on the Left Side

No matter whether you have MS numbness on the left side or elsewhere it can be both painful and inconvenient at best and debilitating as the disease progresses. In most cases the numbness and associated pain is only temporary and will go away on its own. Many patients find that if they ignore the numbness, they can function in spite of it. This might work well for those who experience the milder levels of numbness, once the numbness becomes too painful it might be time to seek some form of treatment.

Most doctors will tell you that there is no reason to prescribe any kind of medication as there really is nothing for mild cases; the only medications are those for the worst case scenarios where the patient has become disabled due to a complete loss of feeling. You will find that eating a healthy diet and participating in a regular exercise regimen will do more to help relieve the MS numbness in the left side or any other part of your body.

Diagnosing and Living With Multiple Sclerosis

Multiple Sclerosis is possibly the most difficult disease to diagnose. The symptoms are vague and widespread, mimicking other diseases. The cause of MS is unknown and there is no cure.

Some Symptoms include:

1) Blurring or Double Vision (usually in one eye)

2) Patches of Body Numbness

3) General Weakness (usually one side of body)

4) Muscle Spasms

5) Fatigue

6) 'Pins and Needles' in extremities

7) Loss of Balance and Coordination

8) Cognitive (ability to think) difficulties

9) Overall Sensitivity to Extreme Heat or Cold

10) Loss of Sensation in Affected Extremity

There are several tests for Multiple Sclerosis. No two people experience the same symptoms, nor do they share the exact same test results. The tests for MS include:

1) MRI (Magnetic Resonance Imaging) of the Brain and Spine

2) Spinal Tap

3) Sed Rate (Lab work to show Inflammation)

4) Nerve Conduction tests (Done in your Neurologists' Office)

Your history of symptoms, family history and physical exam are also considered. You will also be checked for strength, coordination, response to stimuli and how you walk.

Once your diagnosis is confirmed you will be set up for a personalized treatment plan. Physical Therapy helps keep your muscles from atrophy (shrinkage) and stiffness, and Steroid infusions help with inflammation from the damaged nerves. Make sure you tell your doctor if you experience depression. It is important to treat the mental aspect as well.

There are new medications that help to stabilize your symptoms. They have proven to slow down the progression of the disease. Unfortunately, they are very expensive and have some unpleasant side effects. You have to use your personal situation to determine continuation of the treatments.

The biggest keys in fighting this disease are to remain as active as possible, eat a healthy diet, treat symptoms as needed and stay in touch with your local Multiple Sclerosis organizations. They are there to help you. You can speak to other MS patients and get additional support from them.

Don't get overwhelmed, it could always be worse. I had symptoms for 6 years before I was diagnosed and it was actually a relief. Having answers to my long term health problems and knowing there was help did wonders for me. I am also amazed at the support available in the MS community.

Just keep a positive attitude and stay in touch with all the help available to you. Don't fight it alone.

MS Diagnosis Criteria - What Do Doctors Look For When Diagnosing MS?

It can be very difficult for any physician to diagnose a patient with the disease multiple sclerosis. The type of damage that the disease does to the central nervous system can cause symptoms that can be reminiscent of many other neurological problems. In order to make it easier to present such a diagnosis the medical community has developed a set of MS diagnosis criteria that gives physicians the highest chance of detecting the disease at the earliest possible stage.

Initial MS Diagnosis Criteria

Over the years as research has been done the basic MS diagnosis criteria has changed to a certain degree with an eye to making it easier for physicians to catch symptoms that may seem innocuous on their own, but when put together form a pattern that can lead to early diagnosis and treatment. These criteria according to the latest information available from the MS Society of America are:

1. At least two exacerbations with a period of on e month or more between them and physical evidence of two or more lesions.

2. Two or more exacerbations with one confirmed lesion. However an MRI that shows proof of the lesion a spinal tap that results in a positive finding.

3. A single attack and 2 or more lesions as found by an MRI.

4. A single attack and 1 lesion (known as a monosymptomatic presentation) along with an MRI and a positive spinal fluid test.

5. Obvious signs that the symptoms are getting progressively worse. However this must be combined with a positive cerebro spinal fluid test and MRI evidence of multiple lesions.

Other MS Diagnosis Criteria

While the above list includes the official MS diagnosis criteria, there are many symptoms that can be indicative of the disease. Part of the problem with diagnosing multiple sclerosis is that no two people seem to exhibit quite the same symptoms at any given point in the progression. Among the more common symptoms recognized and used to recommend a patient for further testing are visual acuity problems, uncontrollable muscle spasms, weakness in one or more limbs, problems with balance and numbness or tingling in one or more limbs.

These symptoms are among the very first criteria for MS diagnosis and are used by many doctors to recommend that a patient seek further testing. This testing will most likely include blood tests to rule out many other problems whose symptoms mimic those of multiple sclerosis. An MRI of both your head and spinal cord to see if there are any lesions and an evoked response test to see how your brain responds to certain stimuli and whether or not there is any impairment evident.

There is no one single test for MS and the criteria for MS diagnosis leave room for individual diagnosis, but are specific enough to give medical professionals the highest possible chance of catching this disease at the earliest stage. The early it can be diagnosed the more likely a person is to be successful in getting the treatment they need.

What Exactly Is Multiple Sclerosis?

• 
  Multiple Sclerosis is an autoimmune disease

Multiple sclerosis (MS) is a neurological disorder that affects around 2.5 million people worldwide. In this disorder, the body's own immune system acts against the central nervous system - the brain, spinal cord and nerves. Such a condition is referred to as an autoimmune disease. Normally, the immune system defends our body from the attack of foreign elements. The cells concerned with immunity target and destroy the foreign bodies like bacteria and other pathogens. But in MS, the immune system mistakes myelin (a fatty coat that protects the nerve fibers) for a foreign substance and destroys it. That is why Multiple Sclerosis is also called a demyelinating disorder.

Why does the body offend the myelin coat?

It is still not clear why the immune system attacks the myelin substance that is native to the human body. Scientists suggest environmental and genetic factors for this behavior of the immune system. Some researchers also consider that certain viruses can cause this disease. However, there is no strong scientific background for this hypothesis.

• 
  Multiple Sclerosis has no specific pattern of presentation

The disease presents with different symptoms in different patients. There is no definite order in which the symptoms appear. In some patients, the symptoms are mild and go unnoticed during the early stages while in others, disturbing symptoms occur earlier and may last for some time. Though the disease can affect people of all ages, the initial symptoms usually show up between 20 and 40 years of age.

The symptoms depend upon the part of the nervous system affected. The symptoms commonly include visual disturbances, tingling sensations, numbness, bladder and bowel disturbances, dizziness, fatigue, loss of balance, cognitive disturbances, emotional changes, muscle cramps and sexual dysfunction.

Another peculiarity of MS is that it is not possible to predict the disease progression. Some people may show up a symptom that persists for a while and then subsides. They may not have any other symptom for years. While in others, there may be a rapid progression of the disease so that they may show up with many symptoms within a limited period.

• 
  Multiple Sclerosis is difficult to diagnose

There is no specific laboratory test to confirm the diagnosis of Multiple Sclerosis. The symptoms of MS are not specific for this disease. Furthermore, it is very difficult to establish this diagnosis after a single episode of symptomatic attack. The other possible causes of these symptoms need to be ruled out before arriving into the diagnosis of MS. There are various criteria on which the disease can be confirmed. A careful neurological examination is a fundamental requirement for an accurate diagnosis of MS.

It is also necessary that the damage caused to the central nervous system is confirmed by additional methods like imaging techniques, CSF analysis and other specific neurological studies. MRI is the best imaging technique to confirm that the damage has occurred. Another advantage of MRI is that it can pinpoint the site of damage. This when corresponds to the neurological symptom present in the patient, the diagnosis is confirmed.

• 
  Multiple Sclerosis has no curative treatment at present

The available treatment options focus on reducing the frequency and severity of symptoms and slowing the disease progression. Medicines for symptom-management, disease modifying drugs, alternative therapies and diet and lifestyle changes are all aimed at improving the 'quality of life' of the suffering patients. Unfortunately, there is no known cure for the disease at the moment.

Diagnosing MS - How a Diagnosis is Made

Multiple sclerosis can be a devastating disease for anyone who is diagnosed with it. Currently there are no known cures for the disease; however there are a variety of therapies and medications that can help the person diagnosed with MS lead a full life. There is no one test that can be performed for diagnosing MS that can provide proof positive that a person has the disease. Medical professionals do however have a set of criteria that they use to make a diagnosis, but even with this set of established symptoms there are no guarantees.

How is the Diagnosis Made?

Multiple sclerosis can be extremely difficult to diagnose, if you or your family doctor have reason to suspect that you may have MS you need to see a specialist. You will need to be seen by a neurologist who specializes in this disease so that he can fully evaluate your symptoms. According to medical research as many as 10% of patients who are referred for further testing to diagnose MS have another problem or condition that imitates the disease such as multiple strokes, lupus or an infection of the brain.

To make diagnosing MS accurate the specialist will take a close look at your overall medical history and perform a complete neurological evaluation of your spinal cord and brain with a variety of different tests. It requires a highly skilled doctor in this field to not only perform the examinations, but to ask you the right questions so that he can evaluate all of the signs and symptoms you have exhibited. He may also order an MRI to look for lesions, a spinal tap or lumbar puncture to examine your spinal fluid and an evoked potentials test to check for nerve damage.

What Criteria are used?

Because the disease manifests itself in so many different ways the medical field has established certain criteria used in diagnosing MS to help make the chances of early detection and treatment much higher. These include noting that the average onset occurs between the ages of 20 and 50, noticeable signs and symptoms of brain or spinal cord damage according to a know list and signs of at least two lesions on the brain or spinal cord as seen in and MRI.

The patient must also have recorded instances of more than two episodes of the listed symptoms that have lasted more than 24 hours that were more than one month apart and there should be no other way to explain the symptoms described. Once an accurate diagnosis is made the doctor can then recommend a treatment regimen to help the person cope with this degenerative disease. In many cases if it is cause early enough a patient will be able to lead a full life with minimal exacerbations.