5 things to know about Lyme disease and Powassan

The CDC is warning of a high threat of tick-borne illnesses this summer, including the sometimes-deadly Powassan virus. Here are five things you need to know about Lyme disease and Powassan and how to code for them.

Ticks & Summer

The Centers for Disease Control and Prevention (CDC) is predicting that summer 2017 will see a greater number of ticks and tick-borne illnesses across the U.S., possibly the highest number on record. A mild winter is in part responsible for the survival of a larger tick population, thereby increasing the likelihood of cases of Lyme disease and the deadly Powassan virus.

In May, the CDC warned of a greater spread of Powassan, a disease the U.S. has seen only 75 times in the past decade, according to the agency. The virus, seen only in about 4% of deer ticks (vs. the 30%-40% seen with Lyme), is spread more quickly from tick to host.

To date, there are no medications or treatments for Powassan, hence the alert from the CDC for physicians and patients to be even more vigilant against ticks this summer.

Signs & Symptoms

Lyme Disease

(3 to 30 days after tick bite)
• Fever, chills, headache, fatigue, muscle and joint aches and swollen lymph nodes
• Erythema migrans (EM) rash
                  • Occurs in 70% - 80% of infected patients
                  • May feel warm to the touch; rarely itchy or painful
                  • Sometimes clear as enlarges, giving it a target or bull’s eye appearance

Powassan
The CDC notes that many who become infected with Powassan virus don’t develop any symptoms. However, symptoms that could appear are: fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties and seizures. Furthermore, 10% of Powassan virus encephalitis cases are fatal.

Next: Codes to know

Coding – CPT codes

Lyme Disease
86617: Lyme disease confirmation test (Western blot or immunoblot, for example)

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86618: Lyme disease serology
Related codes:

83898: Nucleic acid probe with amplification

83912: Interpretation and report

84181: Western Blot, with interpretation and report, blood or other body fluid

84182: Western Blot, with interpretation and report, blood or other body fluid, immunologic probe for band identification, each

87475: Infectious agent detection by nucleic acid (DNA or RNA); Lyme disease, direct probe technique

87476: Infectious agent detection by nucleic acid (DNA or RNA); Lyme disease, amplified probe technique

Coding – ICD-10 codes

Lyme Disease
A69.20: Lyme Disease, unspecified
Related:
                  • 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

Powassan
A84.8: Powassan / other tick-borne viral encephalitis

Next: Important resources for physicians and patients

Resources for physicians / patients

Physicians looking for more information or patient-education information for their websites or handouts, can visit:

• CDC’s Ticks webpage: bit.ly/CDC-ticks
Site features resources on how to prevent tick bites, removing ticks and symptoms to check for post-bite.

• CDC’s Lyme disease toolkit for physicians:bit.ly/CDC-lyme-toolkit
Featuring brochures in English, Spanish and Brazilian Portuguese, physicians can download information to distribute to patients.

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• CDC’s Powassan resource center: bit.ly/CDC-Powassan
Information and resources for physicians to spot and address possible Powassan cases.

• Infectious Diseases Society of America Lyme Disease CME course:bit.ly/IDSA-lyme-course
Physicians can earn CME credit learning about the clinical assessment, treatment and prevention of Lyme disease.

• LymeDisease.org training and resources for physicians: lyme-MD-resources
The patient advocacy organization provides training opportunities and clinical guidelines to download and share.