Documenting Cerebral Palsy – Symptoms, Types, Diagnosis, Treatment and ICD Codes

Hello everyone and welcome to our podcast series. My name is Natalie Tornese and I’m a Senior Group Manager at Managed Outsource Solutions. Wanted to talk a little bit today about Cerebral Palsy.

Cerebral palsy 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. The damage disrupts the brain’s ability to control movement, 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 – that’s 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 Cerebral Palsy 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.

Cerebral palsy is the most common movement and motor disability in children. Reports suggest that about 1 in approximately 345 kids have Cerebral Palsy. Most children with CP also have other conditions. Epilepsy is one of the common co-occurring conditions. The condition is more prevalent in boys than in girls and 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.

So, most children are born with Cerebral Palsy, but they may not show signs of the disorder until months or years later. Symptoms usually appear before a child reaches the age 3 or 4 years old. The symptoms can vary from person-to-person and range from mild to severe. They also vary depending on the part of the brain that’s affected. Some people may have difficulty walking and sitting, while 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 and neurological problems such as seizures, intellectual disabilities, and blindness.

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

• Spastic CP which is one of the most common types which can cause stiffness and exaggerated reflexes, making it difficult to walk. The symptoms can affect the entire body or just one side.
• Dyskinetic CP – People with this type 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 is a condition that 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 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 when they have this type of CP.
• And then there is mixed CP which is a combination of symptoms from the different types and it’s just called mixed CP.

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. This 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 is characterized by being able to walk without limitations.
• Level 2 – a person can walk long distances without limitations, but they can’t run or jump.
• Level 3 – a person with level 3 CP can sit with little support and stand without any support.
• Level 4 is a person with level 4 CP can walk with the use of assistive devices.
• Level 5– a person with level 5 CP needs support to maintain their head and neck position.

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 testing can include EEGs, MRI, CT scans, 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 the use of assistive aids – like hearing aids, walking aids, body braces, wheelchairs, medications – like oral anticonvulsants and muscle or nerve injections, that are prescribed to decrease muscle tightness, improve functional abilities and treat pain. There are also a variety of therapies that can be prescribed such as physical, speech, occupational and recreational therapy. Surgery may also be required to decrease muscle tightness or correct bone abnormalities caused by spasticity. Surgical modalities include orthopedic surgery and cutting nerve fibers.

I will include a transcript along with this podcast outlining all the associated ICD- codes related to this condition.

ICD- codes of Cerebral Palsy

• 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 decrease 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 your 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.

I hope this helps. But always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!