icd 10 code for opsoclonus

Full Answer

What is the ICD 10 code for myoclonus?

Myoclonus 1 G25.3 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 The 2021 edition of ICD-10-CM G25.3 became effective on October 1, 2020. 3 This is the American ICD-10-CM version of G25.3 - other international versions of ICD-10 G25.3 may differ.

What does opsoclonus mean in anatomy?

Definition of opsoclonus Opsoclonus is a form of saccadic intrusion characterized by multidirectional conjugate eye movements with horizontal, vertical, and torsional directions. The saccades are rapid, involuntary, lack an intersaccadic interval, and do not follow a rhythmic pattern.

What is the ICD 10 code for myoclonic seizures?

Diagnosis Index entries containing back-references to G25.3: Convulsions (idiopathic) R56.9 - see also Seizure(s) ICD-10-CM Diagnosis Code R56.9 Disease, diseased - see also Syndrome Friedreich's myoclonia G25.3 Jerks, myoclonic G25.3

What are the saccadic movements of opsoclonus and ocular flutter?

The saccadic movements of opsoclonus can be horizontal, vertical, and torsional. It should be noted that ocular flutter and opsoclonus fall along a spectrum, and it is possible for ocular flutter to progress to opsoclonus. Thus, ocular flutter in the appropriate clinical context should also raise suspicion for OMS.

What is diagnosis code H55 81?

ICD-10-CM Code for Deficient saccadic eye movements H55. 81.

What is saccadic dysfunction?

Ocular Motor Dysfunction – Deficiencies of Saccadic Eye Movements. DEFINITION: A sensorimotor anomaly of the oculomotor system whose characteristic feature is the inability to perform accurate, effective ocular saccadic and/or fixational eye movement patterns.

What is the ICD-10 code for myoclonic epilepsy?

Juvenile myoclonic epilepsy, intractable, with status epilepticus. G40. B11 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM G40.

How do you code paraneoplastic syndrome?

Recognize when clinical indicators point to paraneoplastic...Musculoskeletal disorders (code 729.90), including. ... Endocrine disorders (code 259.9), including: ... Connective tissue diseases (code 710.9), including scleroderma-like, rheumatoid arthritis-like, and systemic lupus erythematosis-like diseases.More items...•

What is the difference between nystagmus and saccades?

Saccadic intrusions are more often nonrhythmic, intermittent, and unsustained. The initial abnormal eye movement with nystagmus is always a slow drift of the eyes that is also called a slow phase; in contrast, saccadic intrusions are initiated by a fast saccadic eye movement.

What are saccades and pursuits?

Tracking eye movements consist of two different components, namely, smooth pursuit and saccades. Smooth pursuit, or just pursuit, is a class of rather slow eye movements that minimizes retinal target motion. Saccades are rapid eye movements that align the fovea with the target.

Are myoclonic jerks seizures?

What is a myoclonic seizure? Myoclonic (MY-o-KLON-ik) seizures are brief, shock-like jerks of a muscle or a group of muscles. "Myo" means muscle and "clonus" (KLOH-nus) means rapidly alternating contraction and relaxation—jerking or twitching—of a muscle. Usually they don't last more than a second or two.

What is the ICD-10 code for poorly controlled idiopathic epilepsy?

Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus. G40. 309 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

How do you code seizure like activity?

If documentation does not indicate a specific cause for the seizure-like activity it is appropriate to code R56. 9 for unspecified convulsions.

What is paraneoplastic Neuromyopathy and neuropathy?

Sensory Neuromyopathy and Terminal Neuropathy Paraneoplastic sensory neuromyopathy is usually a late effect of cancer on the peripheral nervous system. It presents as a symmetric sensorimotor neuropathy, is usually mild, and can be associated with type 2 fiber muscle atrophy.

What is paraneoplastic profile?

Paraneoplastic autoimmune neurological disorders reflect a patient's humoral and cellular immune responses to cancer. The cancer may be new or recurrent, is usually limited in metastatic volume, and is often occult by standard imaging procedures.

What is paraneoplastic encephalitis?

Paraneoplastic Encephalomyelitis is a subtype of paraneoplastic neurological syndromes. This group of neurological disorders is associated with antibodies against intracellular and extracellular neuronal proteins related to cancer, involving focal or multifocal inflammation of the brain, spinal cord, or both.

What is the ICD code for eye disorders?

ICD Code H57 is a non-billable code. To code a diagnosis of this type, you must use one of the four child codes of H57 that describes the diagnosis 'other disorders of eye and adnexa' in more detail. H57 Other disorders of eye and adnexa. NON-BILLABLE.

What is the ICD code for acute care?

H57 . Non-Billable means the code is not sufficient justification for admission to an acute care hospital when used a principal diagnosis. Use a child code to capture more detail. ICD Code H57 is a non-billable code.

What is the ICd 9 code for saccadomania?

The movements of opsoclonus may have a very small amplitude, appearing as tiny deviations from primary position. Specialty: Ophthalmology. ICD 9 Code: 379.59. Source: Wikipedia.

What is the term for uncontrolled eye movement?

Opsoclonus refers to uncontrolled eye movement. Opsoclonus consists of rapid, involuntary, multivectorial (horizontal and vertical), unpredictable, conjugate fast eye movements without intersaccadic intervals. It is also referred to as saccadomania or reflexive saccade.

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Clinical description

OMS typically presents between 1 and 3 years of age, although it can occur earlier or later in childhood. It is characterized by opsoclonus (rapid, multi-directional, conjugate eye movements), myoclonic jerks, ataxia, irritability and sleep disturbances. The clinical course may be monophasic or chronic relapsing.

Etiology

OMS may have a paraneoplastic, parainfectious or idiopathic origin. In the majority of pediatric paraneoplastic cases, a neuroblastoma is found. Infections triggering OMS include a variety of viral and bacterial agents including streptococci, mycoplasma and varicella zoster.

Diagnostic methods

The diagnosis is clinical, based on the presence of 3 out of the 4 following criteria: 1) neuroblastoma, 2) opsoclonus, 3) a movement disorder with myoclonus and/or ataxia, and 4) behavioural and/or sleep disturbance. Brain MRI in the acute presentation is normal.

Differential diagnosis

Differential diagnosis includes acute inflammatory cerebellar ataxia that is differentiated from OMS by the type of eye movement (nystagmus), the absence of irritability, and the usually rapid recovery without treatment.

Management and treatment

Treatment usually includes resection of the neuroblastoma if present; occasionally, higher grade neuroblastoma may require chemotherapy. Treatment also includes immunomodulation. Treatment regimens have not been standardized but may include corticosteroids, adrenocorticotropin hormone, cyclophosphamide, intravenous immunoglobulin, and/or rituximab.

Prognosis

Outcome is variable. Some children have a monophasic illness, respond well to steroids and have little or no sequelae. Others may be treatment-resistant, have a chronic relapsing course and motor, cognitive and/or behavioral sequelae. Opsoclonus usually remits. The presence or absence of neuroblastoma does not seem to affect outcome.

What is the diagnosis of OMS?

A diagnosis of OMS is mostly based on the presence of the characteristic signs and symptoms. In some cases, laboratory tests for certain antibodies and/or for abnormal white blood cells may also be done. [3]

What are the symptoms of OMS?

Signs and symptoms of opsoclonus-myoclonus syndrome (OMS) may include: [2] [3] Unsteady, trembling gait (manner of walking) Sudden, brief, shock-like muscle spasms (myoclonus). While it occurs most when trying to move and worsens with agitation or stimulation, it can also be present at rest.

What is the treatment for OMS?

There are no official treatment recommendations for OMS. Management may involve: Surgery, chemotherapy, and/or radiation: When there is a tumor present, treatment such as surgery for tumor removal, chemotherapy, or radiation may be required. [2] . In children, the removal of the neuroblastoma does not always improve neurologic symptoms.

What is the term for a tumor that is associated with a paraneoplastic disease?

Opsoclonus-myoclonus syndrome is often associated with the presence of a tumor (such as neuroblastoma) and referred to as a paraneoplastic syndrome. In other cases, it is associated with a viral infection (such as influenza, Epstein-Barr, hepatitis C, HIV,or Coxsackie B) or a bacterial infection (such as as streptococcal, Lyme disease, or mycoplasma). In some cases, the cause is unknown. [2] [3]

What is the treatment for opsoclonus?

Opsoclonus-myoclonus treatment will also typically involve physical and occupational therapy to speed recovery.

How to confirm OMAS diagnosis?

To confirm an OMAS diagnosis, your child will have several tests to look for brain abnormalities and to look for a tumors in the body. A lumbar puncture is often performed to look for evidence of an immune response. Urine tests, including vanillylmandelic acid (VMA) and homovanillic acid (HVA) tests are performed to look for evidence of a tumor. ...

What is OMAS in medical terms?

What is opsoclonus-myoclonus-ataxia syndrome (OMAS)? Opsoclonus-myoclonus-ataxia syndrome (often referred to as OMAS or opsoclonus-myoclonus syndrome) is an autoimmune disorder of the nervous system characterized by new movements of the limbs and eyes, abnormal behaviors, sleep dysregulation, and difficulty talking.

What is an opsoclonus?

Opsoclonus is a form of saccadic intrusion characterized by multidirectional conjugate eye movements with horizontal, vertical, and torsional directions. The saccades are rapid, involuntary, lack an intersaccadic interval, and do not follow a rhythmic pattern. Because of these characteristics, opsoclonus is also often referred to as saccadomania.

How long does it take for opsoclonus to appear?

Opsoclonus is generally observed within days after the onset of ataxia, but has been reported to occur weeks to months later in some cases. This may reflect either a true delay in onset, or it may represent a subtle case of opsoclonus that may not have been recognized at initial presentation.

What is OMS in pediatrics?

In pediatric patients, OMS is commonly a manifestation of a paraneoplastic syndrome secondary to an underlying neuroblastoma. One recent review paper found that 48% of children presenting with OMS had an occult neuroblastoma. 12 In contrast, only approximately 2% of children with neuroblastoma will develop OMS. 13 There is argument that the true incidence of neuroblastoma in association with OMS may be higher than current estimates, with “idiopathic” OMS cases perhaps representing a paraneoplastic syndrome due to a regressed tumor. Furthermore, occult neuroblastoma may go undetected if inadequate radiologic work-up is performed or in the setting of falsely negative traditional laboratory tests. 5 Thus, children presenting with OMS warrant a thorough evaluation to detect an occult neuroblastic tumor (see discussion of work-up, below).

How is opsoclonus different from ocular flutter?

Opsoclonus can be differentiated from ocular flutter because of its multidirectional nature. The saccadic movements of opsoclonus can be horizontal, vertical, and torsional. It should be noted that ocular flutter and opsoclonus fall along a spectrum, and it is possible for ocular flutter to progress to opsoclonus.

What is OMS in neuroblastoma?

Opsoclonus-myoclonus syndrome (OMS) is a rare condition of unknown etiology that features opsoclonus, myoclonic jerks, behavioral disturbances, and ataxia. The leading hypothesis for the cause of OMS is an autoimmune, inflammatory reaction targeting central nervous system tissues, triggered by either a paraneoplastic or an infectious event. Anti-neuronal and anti-Purkinje cell antibodies have been associated with OMS and neuroblastoma in some patients, although many patients have no detectable auto-antibodies. The exact pathophysiology of OMS is unknown; however, there are two proposed mechanisms. The first is that oculomotor neurons of the caudal fastigial nucleus of the cerebellum become disinhibited secondary to Purkinje cell dysfunction in the cerebellar vermis. 3 Purkinje cells normally relay inhibitory signals to cells of the fastigial nucleus. Histopathologic examination of patients with OMS has demonstrated gliosis and inflammation in the cerebellar vermis, supporting this theory. A second potential mechanism is disinhibition of burst neurons, which are cells that normally generate saccadic eye movements. Burst neurons are normally under tonic inhibition from omnipause cells except during saccades. Disruption of this inhibitory signal may cause the saccadic intrusions seen in ocular flutter or opsoclonus. 4

What is the clinical feature of OMS?

The clinical features of OMS have led to the name “dancing eyes-dancing feet” syndrome. It has been described in both pediatric and adult patients. In the pediatric population, OMS is associated with an underlying diagnosis of neuroblastoma in approximately half of cases.

Is otoclonus a complication of labyrinthitis?

Labyrinthitis is a rare complication of acute otitis media that can produce nystagmus and vertigo with secondary ataxia. 10 Patients often have fever, ear fullness, and pain, as well as mastoiditis. Opsoclonus is not a feature of labyrinthitis.

What is OMS in neurology?

Opsoclonus myoclonus syndrome ( OMS ), also known as opsoclonus-myoclonus-ataxia (OMA), is a rare neurological disorder of unknown cause which appears to be the result of an autoimmune process involving the nervous system. It is an extremely rare condition, affecting as few as 1 in 10,000,000 people per year.

What is the condition in which the eyes are not properly aligned with each other?

strabismus (a condition in which the eyes are not properly aligned with each other) vomiting. sleep disturbances. emotional disturbances (including fits of rage) About half of all OMS cases occur in association with neuroblastoma (a cancer of the sympathetic nervous system usually occurring in infants and children).

Is cyclophosphamide effective for neuroblastoma?

Intravenous Immunoglobulins (IVIg) are often used with varying results. Several other immunosuppressive drugs, such as cyclophosphamide and azathioprine, may be helpful in some cases. Chemotherapy for neuroblastoma may be effective, although data is contradictory and unconvincing at this point in time.

Is OMS an infectious disease?

Louis encephalitis, Chikungunya, Epstein-Barr, Coxsackie B, enterovirus, or just a flu) causes the remaining cases, though a direct connection has not been proven, or in some cases Lyme disease. OMS is not generally considered an infectious disease.

Description

Opsoclonus-myoclonus syndrome is a rare autoimmune disorder that affects the nervous system. Inflammation in the neurological system causes this disorder. OMS typically occurs with tumors (neuroblastomas) or after a viral or bacterial infection. The immune reaction to the tumor or infection makes the body attack the nervous system.

Typical Age of onset

The onset is usually abrupt and severe in infancy or childhood. Typically, this disorder occurs in children around 18 months old. OMS can become chronic and it can affect adults.