Parkinson's disease without dyskinesia, with fluctuations

This code identifies Parkinson's disease in patients who do not experience dyskinesia (involuntary, erratic, writhing movements) but do exhibit motor fluctuations. Motor fluctuations refer to unpredictable changes in motor performance, such as "wearing off" of medication effects or "on-off" phenomena, where patients rapidly switch between states of good and poor motor control.

Apply this code when documentation clearly indicates a diagnosis of Parkinson's disease, specifically noting the absence of dyskinesia and the presence of motor fluctuations. This typically occurs when a patient's response to dopaminergic therapy becomes inconsistent, leading to periods of improved and worsened motor symptoms throughout the day. Supporting documentation would include physician notes detailing the patient's motor status, medication response, and the presence of "on-off" states or "wearing off" phenomena.

• Ensure documentation explicitly states "without dyskinesia" and "with fluctuations" to support this specific subcategory.
• Do not use this code if dyskinesia is present, even if fluctuations also occur; a different code would be more appropriate.
• This code is highly specific; avoid using it if the documentation only mentions general Parkinson's disease without further detail on dyskinesia or fluctuations.