Neurostorming (Paroxysmal Sympathetic Hyperactivity): Documentation and Coding Guidance

What Does “Neurostorming” Mean in Clinical Documentation?

• “Neuro storm” and other similar terms such as autonomic storms, hypothalamic dysregulation syndrome and sympathetic storms all equate to the condition paroxysmal sympathetic hyperactivity (PSH). 
• This syndrome was formally named in 2014 by an international panel looking at preferred nomenclature, definition and diagnostic criteria. 
• PSH is defined as a disorder in the regulation of autonomic function most observed in patients with acute brain injury, most notably severe traumatic brain injury. 

Risk Factors Associated With Paroxysmal Sympathetic Hyperactivity

• Traumatic brain injury (TBI) 
• Hypoxic ischemic injury 

Clinical Indicators of Paroxysmal Sympathetic Hyperactivity

• Sinus tachycardia 
• Elevated systolic blood pressure 
• Tachypnea associated with respiratory alkalosis 
• Diaphoresis that can progress to dehydration 
• Hyperthermia in some cases
• Severe cases may have dystonic posturing 

Treatment Approaches Documented for PSH

• Reducing stimulation 
• Managing hyperthermia and hyperventilation 
• Medications 
• IV Morphine 
• Gabapentin 
• Beta blockers 
• Baclofen 
• Precedex infusion 
• Dantrolene 

Coding and CDI Considerations for Neurostorming Documentation

The ICD-10-CM condition code most appropriate for reporting of PSH is G90.89, Other disorders of autonomic nervous system. There is no specific code to identify neurostorm or PSH. There are also no instructional notes for the code G90.89. 

Per the ICD10-CM Official Coding Guidelines, “ If a main term cannot be located, consider a synonym, an eponym, or another alternative term. Once the main term is located, search for subterms, notes, or cross-references. Subterms provide many types of more specific information and must be checked carefully, following all the rules of alphabetization. The main term code entry should not be assigned until all subterm possibilities have been exhausted. During this process, it may be necessary to refer again to the medical record to determine whether any additional information is available to permit assignment of a more specific code. If a subterm cannot be located, the nonessential modifiers following the main term should be reviewed to see whether the subterm may be included there. If not, alternative terms should be considered” 

Current coding advice notes that when the index is confusing, leading to an inappropriate code, further research is needed when the title of the code suggested by the index clearly does not identify the condition correctly. 

Regarding the CDI professional, it is allowable to report code G90.89, Other disorders of autonomic nervous system in the instance where “neurostorm” is documented by the provider. A query would not be needed for clarification.