Coding Dementia
Coding Dementia can be a challenge. Dementia is not a clinical diagnosis, unless an underlying disorder or disorder is identified. It is a term used for cognitive decline, for eg: Forgetfulness, damage to memory, language and thinking. Variety of screenings, blood tests, mental status examination and scanning of brain are done to determine the type of dementia.
Types of dementia:
? Alzheimer’s Disorder (AD) G30- : This disorder begins with memory problems. Symptoms such as memory loss and trouble in planning and doing tasks are noticed in this case. The symptoms become worse over the years though mild initially.
When reporting Alzheimer’s, providers may need to document additional information about the underlying physiological condition in order for coders to choose the most specific code.
? Alzheimer’s disease with early onset G30.0
? Alzheimer’s disease with late onset G30.1
? Other Alzheimer’s disease G30. 2
? Alzheimer’s disease, unspecified G30.9
? Vascular Dementia (MID or VCI): This happens to those who had a stroke. It depends on the part of the brain that gets affected. It is also caused by an infarction or due to impaired blood flow to brain. This begins with trouble in planning, judgment, organizing and decision making.
ICD-10-CM includes two codes to report:
? Vascular dementia, without behavioral disturbance F01.59 and
? Vascular dementia with behavioral disturbance F01.51.
? When reporting F01.51, an additional code should be used, if applicable, to identify wandering in vascular dementia (Z91.83).
? Dementia with Lewy bodies (DLB) G31.83: Also known as Lewy Body Dementia or Lewy Body Disease.Deposits of protein that forms in the brain are called Lewy bodies. It is formed in the cortex of the brain. Symptoms include: Problems in thinking clearly, decision making, paying attention. Trouble in memorizing. Visual hallucinations, blanking out or staring, trembling, slowness and trouble in walking. Talking, walking and kicking in dreams.
? Parkinson’s Dementia (PD or HRS) G20-: This is a disorder of the nervous system. Very similar to Dementia with Lewy bodies. Symptoms are mostly same.
? Mixed Dementia: This has two types of dementia. Alzheimer’s disorder and vascular dementia are the most common combination.The symptoms and treatment is based on the parts of the brain involved and the type of dementia.
? Frontotemporal Dementia(FTD) G31.0 : Cell damage in areas of the brain which is involved in planning, judgment and movement are related to this form of dementia.
? Huntington’s Disorder (HD) G10: Also known as Huntington’s dementia or Huntington’s dementia. Genetic defect that has passed through generations comes under this disorder. The gene for this disorder will be present at birth but the symptoms start showing at age 30 and 50.
? Creutzfeldt-Jakob Disorder (CJD) A81.0: In this disorder, normal proteins in the brain start folding into abnormal shapes. This is a rare condition. Symptoms are problems in concentration and memory, confusion, depression.
? Normal Pressure Hydrocephalus (NPH) G91.2: In this disorder there is build up of fluid in the brain. Draining of the extra fluid helps in treating this disorder.
Coding for dementia in ICD-10
Dementia (F01-F03) is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation. This syndrome occurs in Alzheimer disease, in cerebrovascular disease, and in other conditions primarily or secondarily affecting the brain.
Codes for dementia are located in the F01-F03 categories in ICD-10-CM.
? Vascular dementia F01
? Dementia in other diseases F02
? Unspecified dementia F03
Dementia in other diseases
Per the ICD-10 Coding Guidelines “In most cases the manifestation codes will have in the code title, ?in diseases classified elsewhere.? Codes with this title are a component of the etiology/ manifestation convention. The code title indicates that it is a manifestation code. ?In diseases classified elsewhere? codes are never permitted to be used as first-listed or principal diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition. See category F02, Dementia in other diseases classified elsewhere, for an example of this convention.”
The underlying physiological condition causing the dementia, such as Alzheimer’s (G30.-), Creutzfeldt-Jakob disease (A81.0-), or Parkinson’s disease (G20) needs to be coded first in category F02.
Both Excludes 1 and Excludes 2 notes exists for this category. In ICD-10-CM, Excludes 1 notes indicate mutually exclusive conditions that cannot be coded together.
Excludes 1 note in this category is for
dementia with Parkinsonism (G31.83)
The Excludes2 note in this category is for:
dementia in alcohol and psychoactive substance disorders (F10-F19, with .17, .27, .97)
vascular dementia (F01.5-)
In ICD-10-CM, an Excludes2 note indicates the excluded condition isn’t part of the condition. The additional code can be reported in patients who have both, if desired.
The documentation should include the type of Alzheimer’s disease to avoid the use of unspecified codes.