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.

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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.