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.

Etiology and Manifestation Codes Medical Coding Basics

Okay, I'm confused about the differencebetween etiology and manifestation codes. What is the difference and do you know anyexample… have any examples? And we just happen to have that. This is basic for coders. You know, you don'tprobably really think etiology and manifestation when you're coding. But what's the firstyou need to know is the guidelines. Etiology is telling you what the patient has wrongwith them. Manifestation tells you how the etiology is presenting. So an example of that,250. That's the diabetes with mellitus. That's the etiology. That's what the patienthas. And keepmind, diabetes codes always

have 5 digits, the 250. So they do trick youon the test sometimes and leave oen of those digits off. Okay so let's say our patient is 250.1.That's a type 1 diabetic and it's under control. So if this patient starts havingsome problems, their kidney starts acting up which is common with diabetes. The patientcomesto the office today because they're felling lightheaded and their feet has beenswollen for a week. Nothing seems to alleviate that swelling. The patient's a type 1 diabeti 35 years, their blood pressure's 15098. They've got cluster edemathe anklesbilaterally and have high protein level in

their urine. So this person's sick. They'vegot something going on. Their diabetes is the etiology and they have manifestations.So HTN, that's the abbreviation for hypertension. You've got proteinthe urine Etiologyand Manifestation Codesand you've got edema. These are all signs of renal neuropathy andthat's common with people who's had diabetes for a long time. So our patient codes for this visit is goingto be 250.41 and this code tells you to use the additional code to identify the manifestationwhich is neuropathy, 583.81. So 250.41 is your etiology, 583.81 is for manifestationand there's some other suggestions of ones

that you can look up when you get this onthe replay or you get itthe… you get a copy of this after the webinar. You canpractice those. Pay attention to the guidelines and what it tells you to codeaddition.But that's manifestation from etiology.