Concussion Management 101

## **Causes of concussion** Concussion symptoms don’t always show up right away. Sometimes, they can take several hours to appear. Look for any of these signs after a head injury: ### **Behavioral and cognitive symptoms** These symptoms include: - Confusion or a blank stare - Slow response to questions - Memory gaps (before or after the injury) - Unusual emotional reactions (laughing or crying unexpectedly) - Irritability or acting out of character ### **Physical symptoms** It is also essential to watch out for physical symptoms: - Headache - Dizziness or balance problems - Nausea or vomiting - Blurred vision or seeing stars - Ringing in the ears - Sensitivity to light or noise - Trouble sleeping or feeling unusually drowsy If you notice any of these persistent symptoms, it’s best to consult a healthcare provider as soon as possible to confirm the diagnosis and begin concussion management. If symptoms get worse or severe signs develop, the patient should go to the emergency department.

## **Potential complications** While most concussions resolve with proper rest and concussion treatment, some patients experience persistent post-concussive symptoms that may interfere with daily functioning. Possible complications include: - Post-concussion syndrome: Headache, dizziness, and concentration issues that last weeks or months - Memory or attention problems - Increased sensitivity to light and noise - Mood changes: Anxiety, depression, or irritability - Sleep issues or ongoing fatigue - Second impact syndrome: A rare but life-threatening condition if a second concussion happens before the first one heals In children and adolescents, these effects can also impact development. Early detection, concussion prevention, and proper follow-up make a big difference in treating brain injuries.

## **How to diagnose concussion** There’s no single test that can confirm a concussion. Diagnosis relies on your clinical judgment, based on the injury details, symptoms, and physical signs. ### **Patient history and description of injury** Start by gathering a detailed account of how the injury occurred. Ask about the force of impact, whether there was a loss of consciousness, and what symptoms the patient has experienced since the incident. Also, check for any memory gaps before or after the injury. ### **Symptom assessment** Use a symptom checklist to guide the evaluation. This may include asking about headaches, dizziness, nausea, visual changes, sensitivity to light or noise, difficulty concentrating, or sleep disturbances. ### **Neurological examination** Perform a focused neurological exam to assess mental status, coordination, balance, and cranial nerve function. Look for signs like delayed responses, trouble balancing, or unusual eye movements. ### **Cognitive testing** Simple cognitive tests can help assess memory, attention, and orientation. You might ask the patient to recall words, repeat numbers backward, or describe the date and time. ### **Imaging tests** CT or magnetic resonance imaging (MRI) scans are not routinely used for diagnosing concussion because they do not show any abnormalities. Still, they may be ordered if there are red flags suggesting a more serious traumatic brain injury, such as prolonged unconsciousness, severe headaches, repeated vomiting, or seizures.

## **How are concussions managed?** Effective concussion management supports full recovery and prevents further injury. Below are the key steps in managing concussions: ### **Rest and symptom monitoring** In the first 24 hours to 48 hours after a concussion, patients should avoid both mental exertion and physical activity to give the brain time to heal. Monitoring for worsening symptoms, such as severe headaches or repeated vomiting, is critical during this period. Patients and families should know what to watch for and when to go to the emergency department if symptoms worsen. ### **Gradual return to activity** Light physical activity can be gradually reintroduced after the initial relative rest phase as symptoms improve. A stepwise approach is used, where the patient progresses through stages of increasing activity, starting with light walking and eventually returning to full daily tasks, sports, or returning to school. Each stage of this process should only begin if the patient is symptom-free from the previous stage. For athletes, physicians can follow structured, evidence-based guidelines for sport-related concussion, such as those provided by the sports medicine community (Herring et al., 2021), to help ensure safe and effective concussion treatment throughout recovery. ### **Cognitive support and accommodations** Some patients may need temporary academic or work adjustments during concussion recovery. This might include shorter school days, extra breaks, or reduced screen time. Supporting brain function while avoiding overstimulation is essential in treating brain injuries. Moreover, educating patients and families about the expected recovery process can help reduce anxiety, address mental health issues, and improve adherence to the management plan. If they follow medical advice, most people recover fully from a concussion within a few weeks, though persistent symptoms may require further evaluation or prescription medications.

## **Concussion ICD codes** The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) system is used to classify and code diseases, injuries, and other health conditions. It helps in accurately diagnosing, documenting, and billing for medical conditions and treatments. The S06.0 category of ICD codes specifically relates to concussions. Here are the relevant billable codes: - **S06.0X0A**: Concussion without loss of consciousness, initial encounter - **S06.0X0D**: Concussion without loss of consciousness, subsequent encounter - **S06.0X0S**: Concussion without loss of consciousness, sequela - **S06.0X1A**: Concussion with loss of consciousness of 30 minutes or less, initial encounter - **S06.0X1D**: Concussion with loss of consciousness of 30 minutes or less, subsequent encounter - **S06.0X1S**: Concussion with loss of consciousness of 30 minutes or less, sequela - **S06.0XAA**: Concussion with loss of consciousness status unknown, initial encounter - **S06.0XAD**: Concussion with loss of consciousness status unknown, subsequent encounter - **S06.0XAS**: Concussion with loss of consciousness status unknown, sequela - **S06.0X9A**: Concussion with loss of consciousness of unspecified duration, initial encounter - **S06.0X9D**: Concussion with loss of consciousness of unspecified duration, subsequent encounter - **S06.0X9S**: Concussion with loss of consciousness of unspecified duration, sequela These codes are used to accurately document and categorize different types of concussions based on the patient's symptoms and medical encounter.

## **Carepatron concussion-related tools you can use** Carepatron offers many resources to support you beyond practice management, ensuring you have the tools for effective patient care. Here are some concussion-related tools you can use: - Post-Concussion Syndrome Treatment Guidelines - Sport Concussion Assessment Tool, 5th Edition (SCAT5) - Concussion Symptom Checklist These resources aim to help you better assess and manage concussion-related cases. You can also access treatment plans, intake forms, and other helpful templates to make your work easier and more efficient.

### **References** Agarwal, N., Thakkar, R., & Than, K. (2024, April 29). Concussion. American Association of Neurological Surgeons. https://www.aans.org/patients/conditions-treatments/concussion/ Herring, S., Kibler, W. B., Putukian, M., Solomon, G. S., Boyajian-O'Neill, L., Dec, K. L., Franks, R. R., Indelicato, P. A., LaBella, C. R., Leddy, J. J., Matuszak, J., McDonough, E. B., O'Connor, F., & Sutton, K. M. (2021). Selected issues in sport-related concussion for the team physician: a consensus statement. British Journal of Sports Medicine, 55 (22). https://doi.org/10.1136/bjsports-2021-104235 NHS Inform. (2025, February 21). Concussion symptoms and treatment. https://www.nhsinform.scot/illnesses-and-conditions/injuries/head-and-neck-injuries/concussion/ U.S. Centers for Disease Control and Prevention. (2024, May 16). About mild TBI and concussion. https://www.cdc.gov/traumatic-brain-injury/about/index.html