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Medical Coding News Archives

Uncommon Coding: Brown-Sequard Syndrome in ICD-10-CM

 
May 23, 2012:

Brigid T. Caffrey, BS, CCS, Clinical/Technical Editor

Changes in ICD-10-CM for spinal cord injury now include the identification of the partial spinal cord injury specified as Brown-Sequard syndrome (BSS), as well as the addition of a new “excludes1” note, and newly expanded subcategory of G83.8 and indexing of spinal cord injury.

This condition is also known as Brown-Sequard’s hemiplegia, Brown-Sequard’s paralysis, crossed hemiplegia, hemiparaplegic syndrome, hemiplegia et hemiparaplegia spinalis, and spinal hemiparaplegia. Any unilateral spinal cord injury that is incomplete or hemisection can be identified as Brown-Sequard or incomplete Brown-Sequard syndrome.

The full syndrome is notable for its rarity; the spinal cord must be cut in half (hemisection) on one side of the spinal cord (unilateral). Such an injury could be caused by a penetrating wound to the cervical or thoracic spine, such as a stab or puncture wound to the neck or back. It could also be caused by a closed injury, such as a unilateral facet fracture with dislocation or pressure contusion. More common are incomplete forms of the syndrome that are neurological mixtures of Brown-Sequard with other symptoms.

Brown-Sequard syndrome causes loss of motor function (hemiplegia) with loss of postural sense (proprioception) and fine/light touch below the level of the injury on the same side as the injury (ipsilateral) and loss of the sense of pain (hypalgesia), temperature, and crude touch on the opposite side of the body (contralateral).

New codes in ICD-10-CM make it possible to code spinal cord injuries separately in addition to vertebral fractures as seen by the instructional note to “code also any associated fracture” under the categories where the Brown-Sequard syndrome subcategories are located: S14.14 Brown-Sequard syndrome of cervical spinal cord, and S24.14 Brown-Sequard syndrome of thoracic spinal cord. These codes can be reported when the syndrome is not accompanied by fracture/dislocation but is instead due to blunt trauma or contusion.

This neurological syndrome manifests in nontraumatic conditions also, in which case it is indicated with code G83.81 Brown-Sequard syndrome (other specified paralytic syndromes). Nontraumatic causes include, but are not limited to, spinal cord tumor, ischemia, tuberculosis, multiple sclerosis, transverse myelitis, epidural hematoma, and disc herniation. Multiple codes would show either the underlying cause or the late effect of the underlying cause and the syndrome. An example would be G83.81 and B90.0 Sequela of central nervous system tuberculosis, in which G83.81 is sequenced first as the condition resulting (sequela) from the infection.

The syndrome is considered a complication when it is caused by a procedure or treatment. For example, within one hour of the removal of a lumbar CSF drainage catheter, Brown-Sequard syndrome is identified as a radiological T6-7 spinal cord injury suspected to be from the coiled catheter’s uncoiling and striking one side of the spinal cord. As there was no puncture or hematoma, the injury was from the catheter, not needle trauma, and the injury was noted after the catheter removal, code G97.82 Other postprocedural complications and disorders of nervous system, would be appropriate. In addition, code G83.81 Brown-Sequard syndrome, would be listed, as indicated by the instructional note under subcategory G97.8 to “use additional code to further specify disorder.”

 

 
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