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Chemotherapy-Induced Peripheral NeuropathyMaryam R. Aghalar, DO; Christian M. Custodio, MD DefinitionChemotherapy-induced peripheral neuropathy (CIPN) is damage and dysfunction of the peripheral nervous system secondary to chemotherapeutic agents, including platinum agents, taxanes, vinca alkaloids, thalidomide, bortezomib, and ixabepilone (Table 96.1). CIPN commonly occurs in 30% to 40% of patients, but its incidence can vary from 0% to 70% [1]. The degree of neuronal damage is dependent on many factors, such as the chemotherapeutic agent, the frequency and duration of therapy, the cumulative dose, the use of other neurotoxic agents, and the presence of preexisting neuropathies, most commonly from diabetes [1]. The severity of neuropathy generally increases until cessation of treatment. However, symptoms associated with platinum drugs may progress for weeks to months after treatment completion, a phenomenon called the “coasting” effect [2]. Many scales have been proposed to assess CIPN but lack standardization and reproducibility. The most widely used tool is the National Cancer Institute Common Terminology Criteria for Adverse Events (v4.03) (Table 96.2) [3]. Another scale is called the Total Neuropathy Score, which appears to be more sensitive in detecting changes in CIPN [4]. SymptomsThe onset of symptoms can be sudden or slowly progress over time. Symptoms can vary by what types of nerve fibers are affected. Sensory nerves are more commonly affected first because they have small fibers, they have little capacity for regeneration, and their cell bodies are located in dorsal root ganglion, where they are outside the protective blood-brain barrier. The dorsal root ganglion has a high supply of capillaries that are highly permeable to toxic compounds in the blood [5]. Patients can present with symmetric, distal, length-dependent, “stocking-glove” distribution of painful paresthesia, dysesthesia, cold sensitivity, allodynia, tingling, and numbness. The patients also may report muscle cramps and pain described as burning, lancinating, shock-like, or electric. Motor nerve fiber cell bodies located in the spinal cord are less affected as they are protected within the blood-brain barrier and they also have the capacity for distal sprouting and regeneration. Patients usually present with muscle weakness, myalgias, and difficulty in walking. If autonomic nerves are affected, patients can present with orthostatic hypotension, constipation, urinary retention, irregular heart rate, and sexual dysfunction [6]. Physical ExaminationBuy Membership for Physical Medicine and Rehabilitation Category to continue reading. Learn more here Essentials of Physical Medicine and Rehabilitation Peripheral Neuropathy – Causes, Symptoms, and Diagnosis Code Assignmentby | Aug 21, 2019 | Blog, Medical Billing |
The peripheral nervous system consists of an intricate network of nerves that connects the brain and spinal cord to the rest of the body. Peripheral neuropathy develops when these nerves become diseased or damaged and disrupt the communication between the brain and other parts of the body. The nerve damage can cause pain, impair muscle movement, and affect normal sensation in the arms and legs. Coders in companies offering coding and physician billing services are knowledgeable about nervous system anatomy and conditions, which is necessary to assign the right ICD-10 codes to report diagnosis of peripheral neuropathy. There are different types of neuropathy. Mononeuropathy refers to damage to a single peripheral nerve, while polyneuropathy is a condition where multiple peripheral nerves throughout the body malfunction at the same time. Hereditary neuropathies are genetically passed from parent to child. Acquired neuropathies are caused by environmental factors such as toxins, trauma, illness, or infection. When the cause cannot be identified, the condition is called idiopathic neuropathy. Causes According to the National Institute of Neurological Disorders and Stroke (NINDS), there are more than 100 types of peripheral neuropathy. An estimated 30 million Americans suffer from some type of this disease (www.foundationforpn.org). Common causes of neuropathy include:
Symptoms The symptoms of peripheral neuropathy depend on which nerves are affected: sensory, motor, or autonomic. Common symptoms include: muscle weakness, cramping, and atrophy; loss of reflexes, coordination and balance; extreme sensitivity to touch; blurred vision; decreased or excessive sweating and heat intolerance; difficulty swallowing or breathing; inability to sweat; dizziness and fainting, and sexual dysfunction. Diagnosis A thorough medical history and physical exam is the first step in diagnosing peripheral neuropathy. Based on the results, the neurologist may order the following: nerve conduction and nerve function tests, electromyography (EMG), nerve/skin biopsy, and imaging tests to identify tumors, herniated discs, or other abnormalities that could be exerting pressure on nerves. Blood tests and other lab exams will be recommended to understand the underlying conditions that may cause a neuropathy or cause complications. ICD-10 Codes for Peripheral Neuropathy The peripheral autonomic neuropathy ICD-10 codes fall in the category G90 Disorders of autonomic nervous system, in the section titled “Other disorders of the nervous system.” G90.9 Disorder of the autonomic nervous system, unspecified Codes related to G90.0 are as follows:
Diabetic neurological complications Peripheral, cranial and autonomic neuropathies are chronic manifestations of diabetes mellitus. In ICD-10, coding diabetic neuropathy requires only one code, rather than separate diabetes and neuropathy codes:
Selecting the Diagnosis Code To assign the correct ICD-10 codes, reliable coders will review the physician’s documentation to find indications that support peripheral neuropathy diagnosis and its type. These indications include symptoms that the patient reports during the exam as well as signs and symptoms documented by the physician. They will also determine the underlying cause of the neuropathy. Coders will query the provider if the final diagnosis is not supported by the documentation. Partnering with an experienced neurology coding and medical billing company can ensure timely and error-free claim filing and appropriate reimbursement. What type of neuropathy is caused by chemotherapy?Some chemotherapy drugs and other treatments for cancer can cause peripheral neuropathy, a set of symptoms caused by damage to nerves that control the sensations and movements of our arms, legs, hands, and feet.
Can chemotherapy cause peripheral neuropathy?These nerves carry sensation, control movements of the arms and legs, and control the bladder and bowel. Chemotherapy and other drugs used to treat cancer can cause peripheral neuropathy. This is termed chemotherapy-induced peripheral neuropathy (or CIPN).
What is the ICDICD-10 code T45. 1X5A for Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes .
What are the symptoms of chemotherapy induced peripheral neuropathy?In chemotherapies that affect mainly the sensory nerve fibers, the patients experience unusual sensations (paresthesias), numbness, balance problems or pain. In cases where the motor nerves are affected, the patients may experience weakness of the muscles in the feet and hands.
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Icd 10 code for peripheral neuropathy due to chemotherapy
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