optic chiasm compression is it brain compression

is optic chiasm regarded as a brain compression?  optic chiasm is described as “an X-shaped structure formed by the crossing of the optic nerves in the brain.” but is it brain compression or a nerve disorder?  


  • It is a normal structure in the brain, not a disorder or compression:

    The optic chiasm is an X-shaped structure formed by the crossing of the optic nerves in the brain. The optic nerve connects the brain to the eye. To biologists, the optic chiasm is thought to be a turning point in evolution.

  • I realize my question isn't clear, if there is documentation of optic chiasm compression is it considered brain compression? Mary 
  • My opinion is ‘no’.  The code is intended to report significant compression of the brain - from your description, only a very limited area of the brain is compressed.   The codes for vasogenic edema and compression are intended to be used to report significant conditions that cause symptoms, require management, and/or treatment.  Areas of small, circumscribed lesions (compression, some limited edema) are sometimes found in conjunction with lesions, but I think we have to ask the question as to ‘when may these causes symptoms or be significant enough to be reported’?  

    As an example, with a neoplasm of the brain,  the patient (my anecdotal observations) will often have what is described as a small, circumscribed area of edema adjacent to the lesion.  Or,  after a brain lesion is surgically removed, the patient will have LOCALIZED areas of edema that are  due to limited swelling after the surgery.  I have been advised by our Neurosurgeons that this is a normal reaction to the excision of the lesion, and that Decadron will be provided as prophylaxis.  These are not reportable.

    I look for a mass effect, compression, hernia, midline shift and such, as shown on a CT or MRI.  You should see clinical concern charted for either process, too.

    I realize this is my opinion, only, but this is what I have learned working with my neurosurgery team and also by working clinical validation denials.

    Paul Evans, RHIA, CCDS
  • Thanks Paul.  Mary 
  • Anytime and hope somewhat helpful.
  • I think if that compression is causing any sign symp such as  bitemporal hemianopia, contralateral homonymous hemianopia. It's considered reportable. Otherwise, I agree that it should not be reported. 
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