ICD-10 Code A52.2 | Asymptomatic neurosyphilis Symptoms, Diagnosis, Billing

Asymptomatic neurosyphilis is a stage of syphilis characterized by the presence of Treponema pallidum in the central nervous system without clinical symptoms. It is crucial for accurate diagnosis and documentation, as it aids in appropriate medical billing and public health reporting, ensuring that patients receive necessary follow-up and treatment.

What is ICD-10 Code A52.2 for Asymptomatic neurosyphilis?

ICD-10 Code A52.2 represents Asymptomatic neurosyphilis, a condition where the Treponema pallidum bacterium infects the nervous system without causing overt symptoms. This code should be used in clinical documentation and billing when a patient has a confirmed diagnosis of neurosyphilis but does not exhibit any clinical manifestations.

ICD-10 Code A52.2 – Clinical Definition and Explanation of Asymptomatic neurosyphilis

Asymptomatic neurosyphilis occurs when Treponema pallidum infects the central nervous system without producing noticeable symptoms. This condition can progress to symptomatic stages if left untreated, necessitating medical attention to prevent complications. Early identification is essential for effective management.

Key Clinical Features:

• Presence of Treponema pallidum in cerebrospinal fluid without clinical symptoms.
• Potential for progression to symptomatic neurosyphilis if untreated.
• Often diagnosed through serological testing and lumbar puncture.
• May be associated with a history of untreated syphilis.

ICD-10 Code A52.2 for Asymptomatic neurosyphilis – SOAP Notes & Clinical Use

ICD-10 Code A52.2 is utilized in SOAP notes to document the absence of symptoms while confirming the diagnosis of neurosyphilis. It plays a critical role in both acute and chronic care settings, ensuring accurate assessment and treatment planning.

What Does ICD-10 Code A52.2 for Asymptomatic neurosyphilis Mean in SOAP Notes?

In SOAP notes, ICD-10 Code A52.2 connects subjective reports of potential risk factors with objective findings from diagnostic tests, facilitating a formal diagnosis. This code is vital for ensuring continuity of care, supporting billing, and meeting EHR documentation standards.

Treatment Options for ICD-10 Code A52.2 – Asymptomatic neurosyphilis

Asymptomatic neurosyphilis requires prompt treatment to prevent progression to symptomatic forms. Hospitalization may be necessary for monitoring and management.

Antibiotic Therapy:

• Benzathine penicillin G: 2.4 million units IM once.
• Procaine penicillin: 2.4 million units IM daily for 10-14 days.
• Doxycycline: 100 mg orally twice daily for 14 days (alternative).

Supportive Care:

• Regular monitoring of neurological status.
• Patient education on syphilis transmission and prevention.
• Psychosocial support as needed.

Infection Control:

• Standard precautions to prevent transmission.
• Education on safe sexual practices.

How to Document Symptoms of Asymptomatic neurosyphilis (ICD-10 A52.2) in SOAP Notes

Subjective:

• Patient reports no neurological symptoms.
• History of untreated syphilis.
• No recent changes in health status.

Objective:

• Neurological examination shows no deficits.
• CSF analysis reveals Treponema pallidum without symptoms.
• Serological tests positive for syphilis.

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SOAP Note Guidelines for Diagnosing Asymptomatic neurosyphilis (ICD-10 Code A52.2)

Assessment:

• Diagnosis: Asymptomatic neurosyphilis, confirmed by CSF analysis.
• ICD-10 Code: A52.2.
• Contributing factors: History of untreated syphilis.

Plan:

• Initiate treatment with Benzathine penicillin G.
• Schedule follow-up appointments for monitoring.
• Educate patient on syphilis and safe practices.

Treatment & Plan Section for ICD-10 Code A52.2 – Asymptomatic neurosyphilis

• First-line treatment with Benzathine penicillin G.
• Patient education on the importance of treatment adherence.
• Regular follow-up to monitor for potential progression.
• Consider referral to infectious disease specialist if needed.

Using ICD-10 Code A52.2 for Asymptomatic neurosyphilis in Billing & SOAP Note Compliance

• Ensure accurate documentation of symptoms and history in SOAP notes.
• Use A52.2 for billing when asymptomatic neurosyphilis is confirmed.
• Align treatment plans with clinical guidelines for justified billing.
• Document all relevant findings to support the use of this code.

Related ICD-10 Codes Often Used with Asymptomatic neurosyphilis

• A51.0 – Primary syphilis
• A51.1 – Secondary syphilis
• A51.9 – Syphilis, unspecified

ICD-10 Code A52.2 in Medical Billing and Insurance for Asymptomatic neurosyphilis

ICD-10 Code A52.2 is essential for accurate billing in hospital, ER, or infectious disease care settings.

Billing Notes:

• Document all relevant clinical findings to support the diagnosis.
• Use A52.2 in settings where asymptomatic neurosyphilis is confirmed.
• Ensure compliance with coding guidelines for accurate claims.

Common CPT Pairings: