Support for Formation of an ICD-9 Code for Typical Weight Hydrocephalus (NPH).


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Support for Production of an ICD-9 Code for Ordinary Weight Hydrocephalus (NPH) Michael A. Williams, M.D. Grown-up Hydrocephalus Program Bureaus of Neurology and Neurosurgery Johns Hopkins Doctor's facility Baltimore, MD Exposure In the most recent 12 months:
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Support for Creation of an ICD-9 Code for Normal Pressure Hydrocephalus (NPH) Michael A. Williams, M.D. Grown-up Hydrocephalus Program Departments of Neurology and Neurosurgery Johns Hopkins Hospital Baltimore, MD

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Disclosure In the most recent 12 months: Our project got examination support from Medtronic I have gotten honoraria from Medtronic I am on Codman’s NPH Advisory Panel The substance of this presentation is proposed to be autonomous and free from business inclination. My affiliations are appeared with the end goal of distinguishing proof. I am not speaking to the Johns\' perspectives Hopkins Medical Institutions. Support for ICD-9 Code for NPH

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An asset for patients and families www.hydroassoc.org 888-598-3789 Biannual Meeting May 26-29, 2006 Hyatt Regency Hotel Baltimore, MD Disclosure: I serve on their Medical Advisory Board as a volunteer

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Definition and ICD-9 Coding of Adult Hydrocephalus Ventricular amplification because of adjusted CSF stream or resorption, with or without side effects or neurologic impedance Obstructive Hydrocephalus (331.4) Impairment of CSF stream inside of the ventricular framework Communicating Hydrocephalus (331.3) Impairment of CSF stream or resorption outside the ventricular framework Impaired move through the subarachnoid space Impaired resorption at the arachnoid granulations Support for ICD-9 Code for NPH

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Obstructive Hydrocephalus: Aqueductal Stenosis (331.4) 36-yo man with cerebral pains, syncope, work hindrance Support for ICD-9 Code for NPH

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Communicating Hydrocephalus (331.3) Idiopathic In the elderly, ordinary weight hydrocephalus Chronic, guileful onset Symptomatic (auxiliary) hydrocephalus Post-subarachnoid discharge (aneurysm), post-irresistible, post-traumatic Acute, subacute or incessant onset Support for ICD-9 Code for NPH

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Normal Pressure Hydrocephalus NPH is a treatable type of dementia, walk apraxia and urinary incontinence Treatment is surgical- - shunt insertion Treatable nature of NPH recognizes it from the basically untreatable nature of most dementias Common demonstrative tests don\'t anticipate the result from shunt surgery exceptionally well Support for ICD-9 Code for NPH

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NPH Diagnosis NPH clinically covers with numerous states of the elderly Vascular dementia Degenerative dementias or malady Cervical stenosis/myelopathy Lumbar stenosis Peripheral neuropathy Support for ICD-9 Code for NPH

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Consensus Guidelines Supplement to Neurosurgery September 2005 Important commitment to the writing Identifies existing information and gives great, down to earth counsel Identifies huge crevices in our insight Support for ICD-9 Code for NPH

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INPH Guidelines Diagnostic Algorithm Neurosurgery 2005:57:S2-17-S2-28 Support for ICD-9 Code for NPH

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Treatment results in significant change in NPH Gait and incontinence enhance As appeared by MCV and Hopkins considers Dementia enhances While some level headed discussion in the writing We have distributed 3 papers indicating noteworthy general subjective change Defined as a 4-point change in MMSE, or change by 1 SD in half of the directed neurocognitive subtests, contrasted with the pattern Support for ICD-9 Code for NPH

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NPH Cognitive Improvement Surpasses AD Improvement “Our finding of more than half of INPH patients with huge general intellectual change 3 months after shunt insertion may be an underestimation, as long haul change at 6–12 months has been accounted for in more than 60% of INPH patients. Then again, medicate trials in AD patients with acetylcholinesterase inhibitors did not exhibit a critical distinction in the middle of benchmark and 3-to 6-month posttreatment scores, and not as much as a large portion of the patients accomplished a clinically noteworthy response.” Dement Geriatr Cogn Disord 2005;20:163–168 Support for ICD-9 Code for NPH

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Outcome of 132 Pts with Idiopathic NPH McGirt MJ, Coon AL, Thomas G, Woodworth G, Williams MA, Rigamonti D. Conclusion, treatment and examination of long haul results in idiopathic typical weight hydrocephalus. Neurosurgery 2005;57:699-705. Support for ICD-9 Code for NPH

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The issue with 331.3 There is a wide range of clinical presentation for “communicating hydrocephalus” coded as 331.3 It incorporates basically sick patients in the ICU with hydrocephalus from subarachnoid drain, for instance, and also patients with NPH Support for ICD-9 Code for NPH

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Post SAH Early Hydrocephalus (331.3) Support for ICD-9 Code for NPH

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Post SAH Delayed Hydrocephalus (331.3) Support for ICD-9 Code for NPH

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So why would that be an issue? Our capacity to utilize databases reliant on ICD-9 codes to comprehend a wide range of viewpoints and results of a clinically unmistakable, treatable type of hydrocephalus is weakened We utilized the Medicare SAF to explore expenses of diagnosing and treating NPH Support for ICD-9 Code for NPH

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Health Care Expenditures in 331.3 Methods Retrospective expense examination utilizing the Standard Analytic Files of paid cases for recipients enlisted in both Parts An and B Medicare for 1997 through 2001 (Index year 1999). A 5% test of the SAF yielded an aggregate of 1441 recipients with an analysis code 331.3, including 362 (25.1%) who got a first shunt and 1079 who did not. Support for ICD-9 Code for NPH

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Health Care Expenditures in 331.3 Results The impact of a shunt method on 5-year Medicare uses is an expense decrease of $25,477 (p<.0001) per persistent Potential $184.3 million lessening in 5-year Medicare consumptions After calculating in shunt complexities (17.4% of pts) there was still a $157 million diminishment in 5-year Medicare uses Support for ICD-9 Code for NPH

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BUT We can\'t distinguish what number of these patients had NPH and what number of had different types of 331.3 What about the 75% of 331.3 who were never treated? In light of the maturing populace, the quantity of pts with NPH will rise, thus will social insurance consumptions on the off chance that they are not recognized or treated A remarkable ICD-9 code for NPH will empower us to take after the study of disease transmission, results, and budgetary effect of this imperative issue Support for ICD-9 Code for NPH

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Summary Normal weight hydrocephalus is a particular clinical element, and patients have huge change with treatment another ICD-9 code, 331.5, will advantage patients and the populace by enhancing indicative exactness for the benefit of myself and the Medical Advisory Board of the Hydrocephalus Association, I bolster the making of 331.5 for NPH Support for ICD-9 Code for NPH

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Normal Pressure Hydrocephalus Support for ICD-9 Code for NPH

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Thank you .:tsli

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