Fluoroquinolones and Peripheral Neuropathy

Peripheral neuropathy, this is an often devastatingconditionwhich people develop pain and numbnesstheir hands and feet. Basicallythey're told on the evening news that they should be taking this or that mediion sothat they can get through life. That's treating the smoke and ignoring thefire. Those medicines that you're seeing advertised don't treat the neuropathy, they only treatthe symptoms. But what's causing peripheral neuropathy? Well we know thatAmerica,one of the biggest causes of peripheral neuropathy is being diabetic, which is clearly relatedto the foods that you eat by and large. Becoming a type 2 diabetic amatically increases yourrisk for having peripheral neuropathy and

fact being devastated by it. This is adisease that effects 115 Americans. Let's take a look. So again this is 115 Americans—thisis 20 million Americans afflicted by this disease, that aside from diabetes, we're toldthe cause is unknown. Well maybe that's not exactly true. Last month,the journal Neurology,an incredible study was published describing a relationship between what are called fluoroquinolones,and the risk of developing a peripheral neuropathy. You may not know what fluoroquinolones are,but chances are you may have actually been exposed to fluoroquinolone. These are antibioticsused for treating things like upper respiratory

infections and even urinary tract infections.Things like Levaquin and Cipro are commonly usedwalks. If you have a urinarytract infection, you may have received these mediations. Well, here's what the study showedus: So this is a study publishedSeptember2014 that looked at men between age 45 to 80 years of age followed for a 10 year periodandthis group there were over 6,000 cases of peripheral neuropathy. And they comparedthese individuals to about 25,000 aged match controls, and what they found was that riskfor developing this devastating condition called peripheral neuropathy was doubled inthose individuals exposed to this class of

antibiotics called fluoroquinolones. And whatthe researchers also told us is that, and I quote, quot;Fluoroquinolones have been shownto neurotoxic. Oral fluoroquinolones have also been associated with reported cases ofpsychosis and seizures, which similar to peripheral neuropathy have been shown to be acute eventsoccurring within days of fluoroquinolone use. In light of strong evidence of unnecessaryprescribing of oral fluoroquinolonesthe United States, ians must weigh the riskof PN against the benefits of prescribing FQ when prescribing these ugs to their patients.quot; We've got to practice medicine under the dictumof quot;above all do no harm.quot; One of our most

well respected peer journals is nowtelling us that the use of these mediions—these fluoroquinolone antibiotics is associatedwith doubling of the risk of peripheral neuropathy. A disease which often is not treatable. Sokeep thatmind the next time you think you need an antibiotic for this or that problem,discuss this study with your treating physician. I'm David Perlmutter.

ICD10 Coding and Diabetes

Welcome to CMS eHealth. By October 1, 2015, the new ICDcoding system will beplace for both diagnosesand inpatient procedures. Using ICD10, s willcapture much more information, meaning they can betterunderstand important details about a patient's healththan with ICD9. The new codes reflecthow health care has changed over the past 30 years with manyadvancesal practice.

You'll notice updates,including definition changes, terminology changes,and a lot more specifics. The most obvious change is thatthe code structure has expanded. While the old codes havethree to five characters, the new codes have up to seven, allowing for more detaileddescriptions. The first three charactersrepresent the egory of disease or health condition,followed by a decimal point.

The fourth, fifth,and sixth characters represent al details,such as the cause of the disease, its severity,and its anatomical loion. Let's look at how this all worksusing the example of diabetes. ICD9 has two major egoriesof diabetes codes, diabetes and secondary diabetes, but ICD10 separates Type 1diabetes from Type 2 diabetes. ICD10 also eliminates the broadegory of secondary diabetes,

instead offeringsecondary options, such as underlyingconditions or causes. To capture more details,subegories can be added to represent both compliionsand affected body systems. For example, the diabetessubegories include ketoacidosis,kidney compliions, ophthalmic compliions,neurological compliions, and circulatory compliions.

Let's say a patient has diabetesdue to an underlying condition. That's code E08,followed by a decimal point. Next come the detailsin the form of subegories, starting with the fourth digit. Ketoacidosis, for example,has a fourth digit of 1. To add even more detail,a fifth digit of zero is ketoacidosis without coma, and a fifth digit of oneis ketoacidosis with coma.

These subegoriesstay the same, no matter what type of diabetesis being described. For example, diagnosis code .621 describes the compliionof foot ulcer. So E10.621 is type 1 diabeteswith foot ulcer, and E11.621 is type 2 diabeteswith foot ulcer. In this example,the provider has documented the egory of diabetesand the compliions.

Medical Coding for Pressure Ulcers

Alicia: Pressure ulcers these are fun,not quite as much fun as neoplasms, but most people that start outthe medical fieldwhen they're young they end up working in, they used to be called nursing homes now.They are skilled facilities and stuff like that. So most of us have timethere, andpressure ulcers are something that is kind of the bane of the healthcare profession becausethey are very hard to treat and prevent. Q: It was asked by one of the students previously,pressure ulcers, how do we code them? You have to code the site where it's loed andyou have to code the stage. So, she wanted to know is it site stage, site stage; or isit site, site, stage, stage?

A: First, let's figure out what a pressureulcer is. Pressure ulcers on the skin reduce blood flowto the area. Without enough blood, the skin can die and an ulcer may form. An ulcer isliterally like how you get a cold sore on your lip or something like that. That's what'shappening. You are more likely to get a pressure ulcerif you area wheelchair. It doesn't matter how old you are but you've got constant pressureon your buttocks,your sacrum and stuff. Usually if you'rea wheelchair you can'tfeel, so you don't know when it's starting to go numb.

If you're an older adult, cannot move certainparts of your body without help because of a spinal injury or multiple sclerosis, havea disease that affects blood flow including diabetes or vascular disease like PVD orneuropathy or stuff like that and you're not able to feel. You have Alzheimer's diseaseor another condition that affects your mental status. In other words, you're sitting fora long period of time and you don't think to get up. You have fragile skin, the older you get,if you've noticed if you look at somebody that's a whole lot older than you, you'llnotice their skin gets papery thin and you

can see the vessels and stuff. You have urinaryincontinence or bowel incontinence. Again, this goes with Alzheimer's disease, if you'resittinga chair and Alzheimer's isn't like you forgot where your keys are. Alzheimer'sis like when you can't remember what a key is used for. If you can't remember that youhave to go to the bathroom when you feel that discomfort, you have urinary incontinence.You do not get enough nutrition (malnutrition) that's another keyway to have problems. Here are the main places that pressure ulcersoccur: The back of the neck, the head because of the bed, on your elbows. If you've everhad to be beidden like if you were pregnant

or something, they made you staybed fora long time and you're constantly pushing yourself, sliding yourself upthe bed,you'll get pressure ulcers on the elbows. Your sacrum (the tailbone), buttock area,because that's where people like to lay on their back and stuff, or on their sides orsacrums; that's why they say you have to move every two hours or more often. The ankle andthe heel, you don't think about that, but if you're not moving and your foot sits fortwo hoursone position, your foot can go numb. So, that's the most common places. Let's get into the coding aspect of it. Theseare the common codes for pressure ulcers:

You've got 707.00 and they start with a zero.It goes all the way down to different body parts and they mainly list those red bulletedareas that we were talking about. Then, there are stages. Now these are going to be 707.02codes and each one of those is going to indie a different. I did list all of these becauseI wanted to give you this description so you have a better understanding. Stage 1 is considered a superficial lesionwith discoloration of the skin, but the lesion is not actually an ulcer at this point. Itpresents as a nonblanching reddened area on the skin. Stage 1 indies a higher riskfor serious pressure ulcer but does not cause