Post-concussive syndrome

katrinabgood

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Can some please clarify for me, "post-concussive syndrome?" Our ED docs use this dx all the time for someone who has just been injured. Don't you have to have a concussion first, before you can have post-concussion syndrome? (yes) My question is, then, am I safe in coding 850.9, Concussion, unspecified, when they give PCS as the dx?
 

Mojo

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From Medscape:
Although no universally accepted definition of postconcussive syndrome exists, most of the literature defines the syndrome as the development of at least 3 of the following symptoms: headache, dizziness, fatigue, irritability, impaired memory and concentration, insomnia, and lowered tolerance for noise and light. Confusion exists in the literature, with some authors defining it as symptoms of at least 3 months' duration, while others define it as symptoms appearing within the first week.

Don't assign a code that the provider did not document. Query the providers; seek help from the ED medical director to give them feedback on the choice of codes.
 
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Norwalk
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According to Ingenix coding guidelines

Code 310.2 - Post Concussive Syndrome:

Includes symptoms such as: amnesia, serial headaches, rapid heart beat, fatigue, disrupted sleep patterns, or inability to concentrate.

If treatment takes place within 24- 48 hours of the concussion it may still be in the acute phase (850.xx series), so the physician will need to clarify.

I think the Verteran's Affairs don't require an 850.xx series if you have a code for a TBI (traumatic brain injury). So it's possible that you might be able to assign code 310.2 if a prior record has something like a head injury code (959.01), but I'm not sure. Just a speculation.
 
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Grand Junction, CO
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According to Coding Clinic, Fourth Quarter 1990, page 24:

Concussion/Postconcussion Syndrome

A concussion (850.x-854.xx) results from a blow to the head severe enough to cause a transient or prolonged alteration of consciousness, which may be followed by amnesia, vertigo, nausea, and weak pulse. Breathing may be rapid or slow. The patient may experience a severe headache and blurred vision after regaining consciousness. The patient usually recovers completely within 24 to 48 hours.

Postconcussion syndrome, 310.2, describes a variety of symptoms that are likely to occur for a variable period following a concussion. These symptoms may last up to a few weeks after the concussion. The symptoms most often associated with postconcussion syndrome are headache, dizziness, vertigo, anxiety, fatigue, difficulty in concentrating, depression, heart palpitations, tinnitus, and apathy. Any of the symptoms may cause the patient to seek treatment.

When a patient is treated for symptoms related to concussion within 24 to 48 hours and the diagnosis of "postconcussion syndrome" is documented, the coder should ask the physician if the concussion is still in the current stage and should be coded to concussion, 850.x, rather than postconcussion syndrome, 310.2.
 
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