By Karen Parrish, BA, RHIT, CCS
- Severe headaches and neck stiffness
- Additional EM rashes on other areas of the body
- Facial palsy (loss of muscle tone or droop on one or both sides of the face)
- Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
- Intermittent pain in tendons, muscles, joints, and bones
- Heart palpitations or an irregular heart beat (Lyme carditis)
- Episodes of dizziness or shortness of breath
- Inflammation of the brain and spinal cord
- Nerve pain
- Shooting pains, numbness, or tingling in the hands or feet
SERIOUS CONSEQUENCES OF LYME DISEASE
- Post-Treatment Lyme Disease Syndrome (PTLDS) - Why some patients experience PTLDS is not known. Some experts believe that Borreliaburgdorferi can trigger an autoimmune response causing symptoms that last well after the infection itself is gone. Other experts hypothesize that PTLDS results from a persistent but difficult-to-detect infection. Finally, some believe that the symptoms of PTLDS are due to other causes unrelated to the patient’s Borrelia burgdorferi Unfortunately, there is no proven treatment for PTLDS. Although short-term antibiotic treatment is a proven treatment for early Lyme disease, it doesn’t seem to help taking an antibiotic long term and in fact is associated with serious, sometimes deadly complications. Patients with PTLDS usually get better over time, but it can take many months.
- Neurologic Lyme Disease - Neurologic symptoms of Lyme disease occur when the Lyme disease bacteria affect the peripheral or central nervous systems.
- Lyme Carditis - Lyme carditis occurs when Lyme disease bacteria enter the tissues of the heart. This can interfere with the normal movement of electrical signals from the heart’s upper to lower chambers, a process that coordinates the beating of the heart. The result is something physicians call “heart block,” which can vary in degree and change rapidly. Lyme carditis occurs in approximately one out of every hundred Lyme disease cases reported to the CDC.
- Lyme Arthritis - Lyme arthritis occurs when Lyme disease bacteria enter joint tissue and cause inflammation. If left untreated, permanent damage to the joint can occur. Lyme arthritis accounts for approximately one out of every four Lyme disease cases reported to the CDC.
DIAGNOSIS AND TESTING
The best way to detect Lyme disease is in the laboratory. CDC currently recommends a two-step testing process for Lyme disease. Both steps are required and can be done using the same blood sample. If this first step is negative, no further testing is recommended. If the first step is positive or indeterminate (sometimes called “equivocal”), the second step should be performed. The overall result is positive only when the first test is positive (or equivocal) and the second test is positive (or for some tests equivocal).
Serologic testing is the principal means of laboratory diagnosis of Lyme disease. Current recommendations include using a sensitive enzyme immunoassay (EIA) or immunofluorescence assay, followed by a western immunoblot assay for specimens yielding positive or equivocal results.
As of July 29, 2019, the Food and Drug Administration (FDA) cleared several Lyme disease serologic assays with new indications for use, allowing for an EIA rather than western immunoblot assay as the second test in a Lyme disease testing algorithm.
Key points to remember in testing:
- Most Lyme disease tests are designed to detect antibodies made by the body in response to infection.
- Antibodies can take several weeks to develop, so patients may test negative if infected only recently.
- Antibodies normally persist in the blood for months or even years after the infection is gone; therefore, the test cannot be used to determine a cure.
- Infection with other diseases, including some tick-borne diseases, or some viral, bacterial, or autoimmune diseases, can result in false positive test results.
- Some tests give results for two types of antibody, IgM and IgG.
TREATMENT
People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Early diagnosis and proper antibiotic treatment of Lyme disease can help prevent late Lyme disease.
According to the National Institutes of Health (NIH), which has funded several studies on the treatment of Lyme disease, most people recover within a few weeks of completing a course of oral antibiotics when treated soon after symptom onset. In a small percentage of cases, symptoms such as fatigue (being tired) and myalgia (muscle aches) can last for more than six months. This condition is known as Post-Treatment Lyme Disease Syndrome (PTLDS), as mentioned earlier in this article, although it is also sometimes called chronic Lyme disease.
ICD-10 CODES FOR LYME DISEASE
A69.2 Lyme disease
A69.20 …… unspecified
A69.21 Meningitis due to Lyme disease
A69.22 Other neurologic disorders in Lyme disease
A69.23 Arthritis due to Lyme disease
A69.29 Other conditions associated with Lyme disease
FUN FACTS ARE ALWAYS FUN
Per the CDC:
- Ticks can’t fly or jump. Instead, they wait for a host, resting on the tips of grasses and shrubs in a position known as questing. While questing, ticks hold onto leaves and grass by their lower legs. They hold their upper pair of legs outstretched, waiting to climb onto a passing host. When a host brushes the spot where a tick is waiting, it quickly climbs aboard. It then finds a suitable place to bite its host.
- There is no evidence that Lyme disease is transmitted from person to person. For example, a person cannot get infected from touching, kissing, or having sex with a person who has Lyme disease.
- Untreated Lyme disease during pregnancy can lead to infection of the placenta. Spread from mother to fetus is possible but rare. Fortunately, with appropriate antibiotic treatment, there is no increased risk of adverse birth outcomes. There are no published studies assessing developmental outcomes of children whose mothers acquired Lyme disease during pregnancy.
- Although no cases of Lyme disease have been linked to blood transfusion, scientists have found that the Lyme disease bacteria can live in blood that is stored for donation. Individuals being treated for Lyme disease with an antibiotic should not donate blood. Individuals who have completed antibiotic treatment for Lyme disease may be considered as potential blood donors. Information on the current criteria for blood donation is available on the Red Cross web site.
- Although dogs and cats can get Lyme disease, there is no evidence that they spread the disease directly to their owners. However, pets can bring infected ticks into your home or yard. Consider protecting your pet, and possibly yourself, through the use of tick control products for animals.
- You will not get Lyme disease from eating venison or squirrel meat, but in keeping with general food safety principles, always cook meat thoroughly. Note that hunting and dressing deer or squirrels may bring you into close contact with infected ticks.
- There is no credible evidence that Lyme disease can be transmitted through air, food, water, or from the bites of mosquitoes, flies, fleas, or lice.
- Ticks not known to transmit Lyme disease include Lone star ticks (Amblyomma americanum), the American dog tick (Dermacentor variabilis), the Rocky Mountain wood tick (Dermacentor andersoni), and the brown dog tick (Rhipicephalus sanguineus).
REFERENCES
https://www.cdc.gov/lyme/transmission/index.html
https://www.samhealth.org/about-samaritan/news-search/2018/06/04/lyme-disease-in-oregon
https://elitelv.com/doctors-corner/common-springtime-illnesses/
Check Out Our Other Coding Corner Articles Below:
Understanding the anatomy of the larynx is important to ensure correct coding of diagnoses and procedures. Learn more about the parts and coding procedures to prevent confusion and maintain accuracy.
Evaluation and Management Updates Crossword Puzzle
Test your knowledge about E/M guidelines, codes, abbreviations, patient levels, and more with this printable crossword puzzle created by Christina Crayton, BSHA, CCS, CPC. Then see the answers.
Disease of the Lung Word Scrabble
Unscrabble Disease of the Lung topics. Test your knowledge with the complete printable word scrabble created by Jean Mihelich, RHIA. Then see the answers.
