From the Research
The ICD-10 diagnosis code for decreased sensorium secondary to obstructive hydrocephalus would be G91.1 (Obstructive hydrocephalus) as the primary code, with an additional code for the altered mental status, R41.82 (Altered mental status, unspecified). Obstructive hydrocephalus occurs when the flow of cerebrospinal fluid (CSF) is blocked within the ventricular system, causing increased intracranial pressure that leads to the decreased sensorium or altered consciousness, as noted in a study on the diagnosis and differential diagnosis of hydrocephalus in adults 1. This condition requires prompt medical attention as the increased pressure can cause progressive neurological deterioration.
Key Considerations
- The diagnosis of obstructive hydrocephalus is crucial for the appropriate management of decreased sensorium, and imaging plays a central role in this diagnosis, with magnetic resonance (MR) imaging being the first-line imaging modality, and computed tomography (CT) often used in emergency patients 1.
- Treatment typically involves surgical intervention such as ventriculoperitoneal shunt placement or endoscopic third ventriculostomy to relieve the obstruction and restore normal CSF flow, with recent studies highlighting the importance of individualized treatment approaches, including the establishment of appropriate ventriculoperitoneal shunt pressure based on patient-specific factors 2.
- When coding this condition, it's essential to document the causal relationship between the hydrocephalus and the decreased sensorium to ensure proper sequencing of codes, with the underlying condition (obstructive hydrocephalus) listed first, followed by the manifestation (decreased sensorium).
Recent Evidence
A recent study published in 2023 2 emphasized the significance of treating hydrocephalus in patients with severe disorders of consciousness, highlighting that active treatment can significantly improve patients' consciousness and neurological function, even months or years after the onset of severe disorders of consciousness. This underscores the importance of prompt and appropriate diagnosis and management of obstructive hydrocephalus to prevent long-term neurological damage and improve patient outcomes.