Know When to Use Combination Code for Parkinson’s Dx
Question: Encounter notes indicate a patient is suffering from “Parkinsons w/dyskinesia/fluctuation.” How many ICD-10-CM codes do I need for this condition, and what are dyskinesia and fluctuation in the context of Parkinson’s disease? Utah Subscriber Answer: First, you’ll only need a single combination code for the diagnosis: G20.B2 (Parkinson’s disease with dyskinesia, with fluctuations). As for what dyskinesia and fluctuation are, both have to do with the effects of Parkinson’s medication. According to the Parkinson’s Foundation, “dyskinesias are involuntary, erratic movements caused by some Parkinson’s medications … not by Parkinson’s disease itself.” These movements can affect the face, arms, legs, or trunk and can be of varying severity. “Common types include peak-dose dyskinesia (occurs when medication is strongest) and diphasic dyskinesia (occurs as medication starts or wears off),” per the Parkinson’s Foundation. Fluctuations, also referred to as motor fluctuations, “are changes in the ability to move and are also referred to as ‘on-off’ times. ‘On’ is when Parkinson’s medications are effective and motor and non-motor symptoms are controlled,” according to Stanford Medicine. “‘Off’ time is when Parkinson’s symptoms — motor and/or non-motor — return between medication doses.” Off time can occur in the morning before the patient takes their first medication does, or it can happen during the day, between medication doses. “When it happens between medication doses it may be referred to as ‘wearing off,’” per Stanford Medicine. Chris Boucher, MS, CPC, Senior Development Editor, AAPC
