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September 15, 2008

Coding for Multiple Sclerosis
For The Record
Vol. 20 No. 19 P. 34

Multiple sclerosis (MS) is a chronic, debilitating nervous system disease that affects the brain and spinal cord. It is considered an autoimmune disease because the body’s own immune system destroys the cells that produce the myelin sheath, which is a protective covering surrounding nerve cells. When the myelin sheath is damaged, the nerves become inflamed, which results in scarring (sclerosis). The damage eventually delays or blocks nerve signals that control muscle coordination, strength, sensation, and vision.

MS is an unpredictable disease and varies in severity. It affects more women than men, and the first symptoms usually appear between the ages of 20 and 40. It’s classified to ICD-9-CM code 340.

Symptoms will vary depending on the location of the damaged nerve fibers. Common symptoms of MS include muscle weakness; feelings of numbness, tingling, pain, prickling, or “pins and needles”; vision problems such as loss of vision, double vision, or blurring of vision; a lack of coordination or balance or an unsteady gait; fatigue; dizziness; bladder, bowel, or sexual dysfunction; problems with thinking and memory; emotional changes; depression; and spasticity.

Some less common symptoms associated with MS include speech disorders, swallowing problems, headaches, hearing loss, seizures, respiratory problems, and itching.

Types/Patterns of MS
The following four patterns of MS have been identified:

• Relapsing remitting — alternates between flare-ups lasting for a few weeks or months and periods of remission.

• Primary progressive — gradual decline without periods of remission.

• Secondary progressive — some patients with the relapsing-remitting pattern go into a continuous deterioration.

• Progressive relapsing — primary progressive with sudden episodes of new symptoms or worsened existing symptoms.

MS is difficult to diagnose because symptoms may be due to other conditions, and physicians must rule out other possibilities before MS is confirmed. Physicians may take a thorough medical history to evaluate the signs and symptoms and their pattern. A neurological examination may also be done, which involves testing parts of the nervous system such as reflexes, muscle strength, and sensation of pain. The physician may also order an MRI, which may reveal MS lesions, or perform a spinal tap and evoked potential test.

There is no cure for MS, but medications may slow down the disease’s progression and control the symptoms. Some common medications used to treat MS include the following:

• Beta interferons, which include interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif). These medications fight viral infection and regulate the immune system.

• Glatiramer (Copaxone) blocks the immune system’s attack on myelin.

• Natalizumab (Tysabri) reduces the immune cells’ inflammatory action on brain nerve cells.

• Mitoxantrone (Novantrone) treats aggressive forms of relapsing-remitting MS and certain forms of progressive MS.

• Cyclophosphamide (Cytoxan) treats severe, rapidly progressive MS.

• Corticosteroids treat symptoms of progressive MS.

• Muscle relaxants such as baclofen (Lioresal) and tizanidine (Zanaflex) treat muscle spasticity.

• Amantadine (Symmetrel) helps combat fatigue.

• Modafinil (Provigil) treats narcolepsy.

Besides medications, patients may also receive physical or occupational therapy, counseling, or plasmapheresis.

Coding and sequencing for multiple sclerosis are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.