CTE is coded as postconcussional syndrome which is F07.81
January 30th is National CTE Awareness Day according to www.stopcte.org. This organization was founded by the family of Patrick Risha who lost his battle with chronic traumatic encephalopathy (CTE) when he was in his 20’s. This young man lived in the suburbs of Pittsburgh, Pa. and played youth football, high school football, and on to college football. There have been some recent developments regarding CTE since this topic was discussed on Talk Ten Tuesday in January 2016.
CTE is a degenerative brain disease that has been linked to concussions. A recent study that was released in Brain states that hits to the head without a concussion or other symptoms may lead to CTE. This study also states that up to 20 percent of CTE cases have no history of concussion. The typical symptoms associated with CTE include headaches, dizziness, vision problems, and confusion.
There is also a CTE law suit filed in California against Pop Warner Little Scholars by two mothers whose sons died prematurely. Paul Bright died from a motorcycle accident. Tyler Cornell committed suicide. These mothers allege that their sons’ deaths were related to CTE. The brains have tested positive for the disease. This lawsuit is not the first filed against Pop Warner Little Scholars organization.
Let’s turn towards the coding of this condition and its associated symptoms. Have there been any changes? CTE is coded as postconcussional syndrome which is F07.81. There have been no changes between FY17 and FY18. There are many types of headaches so clinical documentation integrity would be needed to obtain an accurate diagnosis. Consider headache that is post-traumatic, chronic, and will not respond to treatment. This condition would be coded as G44.321 (chronic post-traumatic headache, intractable). Dizziness falls under the ICD-10-CM symptom chapter with code R42. The symptom of vision problems is vague. Here are three considerations: blurred vision (H53.8); vision disturbance with regards to shape and size (H53.15); and diplopia or double vision (H53.2). There are several diagnosis codes for confusion. If the confusion appears to be related to a current head injury, then the code is S06.890A which is mild cognitive impairment due to head injury. The most probable code is specified as a mild memory disturbance due to known physiological cause then the diagnosis code would be F06.8 with F05.
CTE as a principal diagnosis under the inpatient prospective payment system falls to the MS-DRG dyad of 103/102 which is titled “Headache with or without MCC.” The relative weights vary from 0.7497 to 1.0611 which is an increase for MS-DRG 103 FY17 (0.7405) and decrease for MS-DRG 102 (1.0651).
The National Football League (NFL) Super Bowl will be played on February 4, 2018. Remember that these men are risking their physical and mental lives to play this game. Also think about the many boys and men who have lost their lives to play football and did not realize what was happening.
Program Note:
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