Pediatric Neurology Referral Guidelines
The Neurology Practice at Children’s Hospital Central California provides diagnost...
Pediatric Neurology Consultant Reference Guide

         Disease State                         Suggested Work-up          ...
Pediatric Neurology Consultant Reference Guide
                                              Suggested Work-up
Common Pediatric Neurology Conditions
and ICD 9 Codes
 239.6        Brain Tumor                                           ...
Pediatric Neurology Referral Guidelines
Insurance Plans*
Specialty Medical Group (SMG)
Anthem Blue Cross Medi Cal/BC Healt...
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Pediatric Neurology Referral Guidelines


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Pediatric Neurology Referral Guidelines

  1. 1. Pediatric Neurology Referral Guidelines The Neurology Practice at Children’s Hospital Central California provides diagnostic services, medical treat- ment, and follow-up care to infants, children, and adolescents who have suspected or confirmed neurological disorders. Our pediatric neurologists manage and treat a variety of patients including those with epilepsy disorders, neuromuscular disorders and spasticity. Neurologists also provide subspecialty services in Merced, Modesto and Visalia, providing children and families with access to care close to home. A pediatric neurologist has completed a residency in pediatrics and had additional training in adult and child neurology. Most pediatric neurologists have certification from the American Board of Pediatrics and the American Board of Psychiatry and Neurology (with special competency in child neurology). Pediatric neurologists combine the expertise in diagnosing and treating disorders of the nervous system (brain, spinal cord, muscles, nerves) with an understanding of medical disorders in childhood and the special needs of the child and their family. In many cases, pediatric neurologists work as a team with pediatricians or other primary care doctors. In addition, pediatric neurologists may work with other pediatric specialists to care for children with more complex or serious medical issues, such as epilepsy, birth defects, or mental retardation. The Following conditions may be best treated by a pediatric neurologist: • Abnormal/involuntary movement disorders (e.g. tics, ataxia, chorea) • Cerebral palsy with seizures • Developmental disorders, including delayed speech, motor milestones, and coordination issues • Developmental Regression • Headaches/Migraines with no response to first line medications • Hydrocephalus • Neurological aspects of head injuries and brain tumors • Mental retardation • Seizure Disorders, including seizures in newborns, febrile convulsions, and epilepsy • 2nd seizure in 1 year • <1 year of age • Recent onset associated with traumatic brain injury • In association with genetic syndrome, metabolic abnormality, or cerebral palsy • Suspected Muscular Dystrophy • Weakness – Non-acute, including cerebral palsy, muscular dystrophy, and nerve-muscle disorders Children’s Hospital Central California •
  2. 2. Pediatric Neurology Consultant Reference Guide Disease State Suggested Work-up When to Refer and Initial Management Headache -Patients with recurrent headache and a normal -Recurrent headache has been neurologic exam generally do not require ancil- present for at least 6 months or lary testing for patients with headache associ- ated with focal neurologic -MRI suggested for patients who have headaches deficits that awaken them in the middle of the night, or begin shortly after rising from bed in the morn- -Patients with a new severe ing, or are associated with transient neurologic headache of acute onset, head- deficits ache with a focal neurologic defi- cit, or headache associated with -All patients should have a fundoscopic exam to papilledeman should be referred evaluate for papilledema prior to their referral to the Emergency Department Febrile Seizures -Infants and toddlers up to 6 years with simple -Children with multiple recur- (benign) febrile seizures do not require brain rences of simple febrile seizures imaging, EEG, or neurological consultation may benefit from consultation on a case-by-case basis -Consultation may be considered for children with atypical (complex) febrile seizures, defined as lasting >15 minutes, a febrile seizure with partial onset, focal features during the seizure, or recurrent febrile seizures within 24 hours of the first episode. First Afebrile Seizure -An awake and asleep EEG is optional after a first -after second event (EEG highly unprovoked afebrile seizure. Prefer EEG obtained recommended) at Children's. EEG should be scheduled at least 1 week after initial event Recurrent Unprovoked Seizures -Awake and asleep EEG preferably at Children's -Consulting neurologist will (epilepsy) provide the primary care -MRI optional phsyician with recommenda- tions for further evaluation and management Children’s Hospital Central California •
  3. 3. Pediatric Neurology Consultant Reference Guide Suggested Work-up Disease State and Initial Management When to Refer Cebral Palsy combined with -documentation of current interventions, therapies, -After completion of imaging epilepsy or other movement and treatments study and work up disorder -description of functional limitations -brain images such as MRI, CT, or ultrasound -x-rays of the spine and lower extremities (for movement issues) Hypotonia/Suspected -serum CPK After completion of study refer to Neuromuscular Disease Neurology Clinic Developmental Delay -some method of developmental screening/surveil- - Refer to Central Valley Regional lance indicating global delay or delay in specific Center and then possibly area (esp birth to age three assessments) Neurology Clinic dependent on completed results of evaluation Spasticity Management -medical work-up to determine the cause of the -spasticity that causes pain, spasticity or other movement disorder should be functional impairment, or care completed prior to seeking consultation difficulties should be referred to Physiatry Clinic -GMFCS rating if this assesment tool was used to determine functional limitations -related radiologic testing (CT scans, MRIs of the head or spine and x-rays of the spine and hips) -spasticity evaluation Children’s Hospital Central California •
  4. 4. Common Pediatric Neurology Conditions and ICD 9 Codes 239.6 Brain Tumor 357.9 Neuropathy (NOS) 314 ADD 345.40 Sz Complex partial 314.01 ADHD 345.41 Sz Complex partial Intract 299.80 Asperger Disorder 345.10 Sz Generalized Convulsive 299 Autism 345.11 Sz Convulsive Intract 307.22 Chronic Tic Disorder 345.90 Sz Epilepsy (NOS) 315.39 Dev Delay Language 345.91 Sz Epilepsy Intract (NOS) 315.5 Dev Delay Mixed 345.50 Sz Focal – Motor 315.4 Dev Delay Motor 345.51 Sz Focal-Motor Intract 318 Mental Retardation (extent) 345 Sz Gen Non-Conv 319 Mental Retardation (NOS) 345.01 Sz Gen Non-Conv Intract 307.23 Tic Disorder (Motor Ver) 345.3 Sz Grand Mal Status 307.20 Tic Disorder (NOS) 345.6 Sz Infantile Spasms 343.0 C P Diplegic 345.61 Sz Infantile Spasms Intract 343.1 C P Hemiplegic 345.80 Sz other Epilepsy 343.9 C P Infantile (NOS) 345.81 Sz Other Epilepsy Intract 343.4 C P Infantile Hemiplegia 345.2 Sz Petit Mal Status 343.3 C P Monoplegic 436 Stroke 343.8 C P Other 728.9 Muscle Weakness 343.2 C P Quadriplegic 737.30 Scoliosis – Acquired 333.5 Chorea 745.2 Scoliosis – Congenital 323.9 Encephalitis (NOS) 758 Down’s Syndrome 333.4 Huntington’s Chorea 784 Headache 331.4 Hydrocephalus 781 Involuntary movements 346.9 Migraine (NOS) 780.31 Seizure Disorder Febrile 346.10 Migraine Common 854.0 Brain Inj w/ open wound 335.2 Motor Neuron Disorder 854.1 Brain inj w/out open wound 359.21 Myotonic Muscular Dystrophy V71.2 Neuro Disorder Suspected Children’s Hospital Central California •
  5. 5. Pediatric Neurology Referral Guidelines Insurance Plans* Specialty Medical Group (SMG) Anthem Blue Cross Medi Cal/BC Healthy Families HMO Anthem Blue Cross Prudent Buyer Plan (PPO) Admar PPO Aetna PPO Allcare IPA Blue Shield PPO CCN/First Health Community Health Plan Delano IPA GEMCare IPA GreatWest Healthcare (PPO) Health Plan of San Joaquin HealthNet Healthy Families and Healthy Kids (Merced County) HealthNet Managed Medi-Cal Healthnet PPO Hill Physician Medical Group Interplan Kaiser Permanente HMO Kern Family Healthcare Key Medical Group IPA Medcore Medical Group IPA Medi-Cal (i.e. California Children’s Services-CCS) Medicare Mosaic Medical Group IPA MultiPlan Sante Medical Providers IPA Sutter Gould Medical Group TriWest (Formerly TRICARE/CHAMPUS) United Healthcare PPO * If you do not see your plan, please call to verify coverage by calling 559-353-8800/888-824-5439 Children’s Hospital Central California •