[Mark in Idaho]

One of my sources of research is online CME courses. These are the Continuing Medical Education courses that are required for medical professionals to maintain their credentials/board certifications, etc.

During a recent course taught be a multi-disciplinary group of specialists who, combined, begin to rate at an expert level, one important point was made:

One expert stated that the first priority with concussion is to stop denying care to PCS subjects. He stated that this requires that medical records properly list concussion as an early diagnosis (ICD-9 diagnostic code 854.0 ). This way, when symptoms become evident at a later date, they can be considered as possibly caused by the previous/recent concussion. Otherwise, later care is refused and the symptoms are labeled somatoform, psychological, or malingering.

The comments focused on the comprehensiveness of a medical history. This included asking specific leading questions. It was recognized that most concussion subjects are poor at self reporting. Thus, they need to be queried as to any slips, falls, or other accidents that may have caused any level of impact to the head.

This might even include asking if the subject plays any sports like hockey, basketball, football, soccer, rugby, baseball, lacrosse, etc. where impacts to the head are common during play. The importance of this was to include the risk that a head impact may have occurred that was disregarded or forgotten (may times due to short term amnesia during the moments of impact).

They discussed the need to probe into any vague symptoms such as foggy brain, spinning head, just not feeling myself, groggy, and the vast myriad of subjective complaints that are often overlooked. If any of these complaints could be a result of a concussion, they should be considered as possibly due to a concussion until a concussion of any severity is ruled out.

They implied that it is better to have a medical record state 'possible concussion, ICD-9 code 854' to allow for follow-up without a conflict with the second party health care payer.

As most of us have run into the wall of denial of care, this recommendation make total sense. Maybe we need this post to be a 'sticky' that discusses the priorities of a concussion from this perspective. I would suggest that many of us have had somatoform, malingering, hypochondriac, etc stated in our medical records because there was never a proper previous listing of concussion nor a proper medical history taken.

We all need to consider that we have the greatest influence in the care we receive. If we just sit back and wait on others to stick up for our concussion needs, we will be left wanting.