The Latest Disease Scare: Acute Flaccid Myelitis

There is no specific code for this condition at the present time.

Acute flaccid myelitis (AFM) is a rare and serious condition that affects the areas of the spinal cord called the gray matter and has been in the news recently.

According to the Center of Disease Control and Prevention (CDC), cases started to increase in 2014. This illness seems to be spreading across the United States with 62 confirmed cases in 22 states in recent CDC reports. The total cases since 2014 is 386 which is less than one in a million. 

The potential causes are viruses (polio, non-polio enterovirus, West Nile virus, or adenovirus), environmental toxins, and genetic disorders. AFM is mostly affecting children. It appears that the key virus is EV-D68 which is an enterovirus which is related to the poliovirus.

The presenting symptoms are the following:

• Arm or leg weakness
• Facial droop/weakness
• Difficulty moving eyes
• Drooping eyelids
• Difficulty with swallowing or slurred speech

The most severe symptom is acute respiratory failure which may require the use of a ventilator.  

The biggest issue is that providers do not routinely test for viruses nor to most people seek medical advice for a virus. The virus may have cleared the immune system by the time a patient seeks medical treatment. The other issue is that many viruses cause neurological symptoms. The good news is that none of the patients have test positive for polio.  

If your child should develop any of the above symptoms, the CDC recommends to seek medical care immediately. The physician may collect information about the symptoms to be provided to the CDC which is in the process of gathering data about this condition. CDC has also alerted physicians to be aware of these symptoms.

The best treatment for this illness is intensive rehabilitation as soon as possible. This treatment can be done as an inpatient or outpatient. The intensive treatment can include electrical stimulation, gait training, and aquatic therapy. This treatment is similar to patients who have suffered spinal cord disease with related paralysis. 

Now, let’s look at the coding of this condition. When reviewing the ICD-10-CM FY19 Index under the main term of Myelitis, the sub-terms are not appropriate not provide any specificity. The main term has a non-essential modifier of acute. The default code is G04.91 (Myelitis, unspecified). There are no coding instructions at the chapter or category level in the Tabular. In order to provide some specificity, the coder may want to add some of the symptoms such as facial weakness (R29.810), muscle weakness (R62.81), or dysphagia (R13.10). 

Perhaps the CDC will create a specific code for this condition as it seems to be on the rise since 2014. The data would be much more granular with a specific code. A new code could be implemented in April with a public health concern, but no word as of yet. 

Resources:

www.cdc.gov/acute-flaccid-myelitis/about-afm.html

Program Note:

Listen to Laurie Johnson report this story during today’s Talk Ten Tuesdays, 10-10:30 a.m. ET.

Comment on this article