What Is Cerebral Palsy?

by Outsource Strategies International Medical Billing Company

Cerebral palsy (CP) is a group of neurological disorders that affect movement and muscle tone or posture. Regarded as the most common form of disability, the condition is caused by damage to or abnormalities inside the developing brain (most often before birth) that disrupt the brain’s ability to control movement and maintain posture and balance. Typically, the terms cerebral - refers to the brain and palsy – refers to the loss or impairment of motor function. The condition most commonly affects the motor area of the brain’s outer layer - called the cerebral cortex - the part of the brain that directs muscle movement. In some cases, the cerebral motor cortex may not develop normally during fetal growth. In others, the damage is a result of injury to the brain either before, during, or after birth. In either case, the damage is not repairable and the disabilities that result are permanent. Cerebral palsy’s effect on function varies greatly. Some affected people can walk, others need assistance. In some other cases, people show normal or near-normal intellect, but others have intellectual disabilities. Children and adults with CP require long-term care with a medical care team. To treat the condition, medications are often combined with a variety of physical, occupational, speech and recreation therapies. Neurologists, pediatric neurologists or other specialists treating the condition can rely on medical coding companies to get the correct codes reported on their medical claims.

Cerebral palsy is the most common movement and motor disability in children. Reports suggest that about 1 in approximately 345 kids have CP. Most children with CP also have other conditions. Epilepsy is a common co-occurring condition. The condition is more prevalent in boys than in girls. In many cases, the exact cause behind this condition is unknown. Common factors that can lead to problems with brain development include – gene mutations, bleeding into the brain, infant infections, traumatic brain injury, and fetal stroke.

What Are the Early Symptoms?

Most children are born with CP, but they may not show signs of a disorder until months or years later. Symptoms usually appear before a child reaches age 3 or 4 years. The symptoms of CP vary from person-to-person and range from mild to severe. They also vary depending on the part of the brain that was affected. Some people with CP may have difficulty walking and sitting, while some others can have trouble grasping objects. Some of the more common symptoms include - variations in muscle tone, delays in speech development and difficulty speaking, tremors or involuntary movements, lack of muscle coordination, difficulty walking, favoring one side of the body (such as reaching with one hand) and neurological problems such as seizures, intellectual disabilities, and blindness.

Types of Cerebral Palsy (CP)

There are different types of CP that affect various parts of the brain. Each type causes specific movement disorders. The types of CP are –

· Spastic CP – One of the most common types, Spastic CP causes stiff muscles and exaggerated reflexes, making it difficult to walk. The symptoms can affect the entire body or just one side of the body.

· Dyskinetic CP - People with dyskinetic CP have trouble controlling their body movements. The disorder causes involuntary, abnormal movements in the arms, legs, and hands, making it difficult for the affected person to walk, sit, swallow, or talk.

· Hypotonic CP – This condition causes diminished muscle tone and overly relaxed muscles. The arms and legs move very easily and appear floppy. Babies with this type of CP have little control over their head and may have trouble breathing.

· Ataxic CP – This is the least common type of CP which is characterized by voluntary muscle movements that often appear disorganized, clumsy, or jerky. People have problems with balance and coordination.

· Mixed CP - Some people have a combination of symptoms from the different types of CP and this is called mixed CP.

How Is Cerebral Palsy Classified?

Cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS). The World Health Organization (WHO) and the Surveillance of Cerebral Palsy in Europe developed the GMFCS as a universal standard for determining the physical capabilities of people with CP. The system focuses on the person’s ability to sit, the capability for movement and mobility, charting independence and the use of adaptive technology. The five levels of the GMFCS increase with decreasing mobility –

· Level 1 CP - characterized by being able to walk without limitations.

· Level 2 CP - a person can walk long distances without limitations, but they can’t run or jump.

· Level 3 CP - a person with level 3 CP can sit with little support and stand without any support.

· Level 4 CP – a person with level 4 CP can walk with the use of assistive devices.

· Level 5 CP – a person with level 5 CP needs support to maintain their head and neck position.

Diagnosing and Treating Cerebral Palsy (CP)

Diagnosis of cerebral palsy may begin by taking a complete medical history, performing a physical exam that includes a detailed neurological exam, and evaluating the symptoms. Other additional testing includes - Electroencephalogram (EEG), MRI scan, CT scan, Cranial Ultrasound and blood tests. Tests for neurological problems may help detect - vision loss and impairment, deafness, speech delays, movement disorders and other intellectual disabilities.

The goal of treatment is to improve limitations and prevent complications. Treatment may include use of assistive aids, medications, therapies and surgery (in severe cases). Assistive aids like – hearing aids, walking aids, body braces and wheelchairs are recommended. Medications like oral anticonvulsants and muscle or nerve injections are prescribed to lessen muscle tightness, improve functional abilities and treat pain. A variety of therapies – physical therapy, speech and language therapy, occupational therapy and recreational therapy are recommended as part of the treatment. Surgery may be required (in severe cases) to lessen muscle tightness or correct bone abnormalities caused by spasticity. Surgical modalities include orthopedic surgery and cutting nerve fibers (selective dorsal rhizotomy).

Specialists making a diagnosis and providing different treatments must report the same on their medical claims using the correct medical codes. It is important for physicians to have adequate knowledge about the various medical codes when carrying out medical billing and coding activities. The ICD codes that are used to report CP are –

· G80 - Cerebral palsy

· G80.0 - Spastic quadriplegic cerebral palsy

· G80.1 - Spastic diplegic cerebral palsy

· G80.2 - Spastic hemiplegic cerebral palsy

· G80.3 - Athetoid cerebral palsy

· G80.4 - Ataxic cerebral palsy

· G80.8 - Other cerebral palsy

· G80.9 - Cerebral palsy, unspecified

One of the most common problems associated with cerebral palsy is that it cannot be prevented; however it is possible to lessen risks. Women who are pregnant or planning to become pregnant, can take essential steps to minimize pregnancy complications. It is important to get vaccinated against diseases that can cause fetal brain damage, such as rubella. Adequate prenatal care is also essential. Attending regular appointments with the physician during pregnancy can help prevent premature birth, low birth weight, and other infections. There is no cure for CP, but the condition can often be treated and managed effectively.

As neurology medical coding is challenging and time-consuming, physicians can consider the support of experienced medical coding service providers. Coders in reliable medical billing and coding companies would ensure accurate reporting of correct diagnostic details and this in turn will help avoid denied and delayed claims.