October Coding Update

Coding your home health claims is a multifaceted process fraught with complicated issues.  The October 1^st, 2023, update including expanded Parkinson’s codes is just such an issue. Gone are the days of choose one code and go.

Let’s look at this expansion.  The changes to these diagnosis codes began in September of 2021 with a proposal to the ICD-10 Coordination and Maintenance Committee Meeting.  Sunovion Pharmaceuticals Incorporated along with 39 Movement Disorder Specialists (MDS) and the Unified Parkinson’s Advocacy Council (UPAC) requested new codes to enhance the tracking and progression of Parkinson’s disease. As a reminder, Parkinson’s disease (PD) is a progressive neurodegenerative disease that presents with motor symptoms such as bradykinesia with muscle rigidity, tremor, and/or postural instability, as well as non-motor symptoms such as anxiety/panic attacks, problems with executive function, and pain.  These symptoms occur as cells are responsible for producing dopamine die off or are impaired.  Parkinsonism is a general term that refers to a group of neurological disorders that cause movement problems similar to those seen in Parkinson’s disease such as tremors, slow movement and stiffness. The code set has separated Parkinson’s and Parkinsonism into different codes with the October 1^st code update.

The expanded Parkinson’s codes now give us the option to capture dyskinesia and fluctuations of on and off states.  When the code changes for Parkinson’s were proposed, the ICD-10 Coordination and Maintenance Committee Meeting explained that motor fluctuations are typically described as periods of good motor function (ON state) followed by periods when PD symptoms reemerge (OFF state) or when uncontrollable hyperkinetic movements are present. A wide range of symptoms have been observed during OFF states such as tremor, rigidity, bradykinesia, difficulty with speech and balance, weakness, and reduced dexterity. Response fluctuations may also present as nonmotor symptoms. Non-motor symptoms that have been reported to occur during fluctuations include apathy, anxiety, irritability, mood changes, cognitive changes, fatigue, pain, and drenching sweats. Remember, provider documentation must be present to capture dyskinesia or fluctuations in the code that is chosen.  

Here are the updated codes:

• G20.A1 Parkinson’s disease without dyskinesia, without mention of fluctuations (default code for Parkinson’s NOS when no other documentation is present)
• G20.A2 Parkinson’s disease without dyskinesia, with fluctuations
• G20.B1 Parkinson’s disease with dyskinesia, without mention of fluctuations
• G20.B2 Parkinson’s disease with dyskinesia, with fluctuations
• G20.C Parkinsonism, unspecified

Under PDGM, all of these codes provide a low comorbidity adjustment when in field 2-25 and contribute to a high comorbidity adjustment.