Anesthesia Coding Alert

Severity and type of disturbance will guide you to the correct code.

A dementia diagnosis code can be the key to proving medical necessity for anesthesia or sedation when a service doesn’t usually require those services. The 2023 ICD-10-CM code set is bringing a lot of changes to coding for dementia, so be sure you’re ready before the codes become effective Oct. 1, 2022.

Hint: The existing codes in ICD-10-CM 2022 leave a lot of room for expansion. “These limited codes do not adequately describe the associated behaviors or disorders such as agitation, anxiety, mood disturbances, and psychotic disturbances. They also lack specificity that addresses the current severity of the condition,” says Kate Tierney, CPC-I, CPMA, CPC, CPC-P, CRC, COGC, CGSC, CEMC, CEDC, CBCS, CMAA, CICS, CHI, CEHRS, CPhT, national coding trainer for Optum RQNS in Highlands Ranch, Colorado.

Find Out What’s New for Vascular Dementia Coding

Start your preparations by learning the changes coming for F01.- (Vascular dementia) in ICD-10-CM 2023.

According to the Mayo Clinic, “vascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to your brain” (www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793).

While F01.51 (Vascular dementia with behavioral disturbance) is a complete, reportable code in ICD-10-CM 2022, this is not the case in the 2023 code set. You will need to add an additional character for payers to accept the code. The descriptor will change in 2023, as well: F01.51- (Vascular dementia, unspecified severity, with behavioral disturbance).

The 2023 complete codes will vary based on the type of behavioral disturbance:

• F01.511 (Vascular dementia, unspecified severity, with agitation)
• F01.518 (Vascular dementia, unspecified severity, with other behavioral disturbance)

ICD-10-CM 2023 will also add other new codes for vascular dementia, which will ask you to clarify these elements of the patient’s condition:

• Severity (such as unspecified, mild, moderate, or severe)
• Presence or absence of disturbances (such as psychotic, mood, anxiety, agitation, or other behavioral disturbance)

Here’s a sampling of new codes you’ll find in the F01.- category in ICD-10-CM 2023 (this is not a complete list):

• F01.52 (Vascular dementia, unspecified severity, with psychotic disturbance)
• F01.A11 (Vascular dementia, mild, with agitation)
• F01.A4 (Vascular dementia, mild, with anxiety)
• F01.B0 (Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety)
• F01.B18 (Vascular dementia, moderate, with other behavioral disturbance)
• F01.C2 (Vascular dementia, severe, with psychotic disturbance)
• F01.C3 (Vascular dementia, severe, with mood disturbance)

Watch for Similar Changes for Dementia in Other Diseases

ICD-10-CM 2023 will also bump up the total number of codes for dementia in other diseases classified elsewhere, which you’ll find under F02.- (Dementia in other diseases classified elsewhere).

Additional characters required: ICD-10-CM 2023 will change reportable code F02.81 (Dementia in other diseases classified elsewhere with behavioral disturbance) into subcategory F02.81- (Dementia in other diseases classified elsewhere, unspecified severity, with behavioral disturbance).

The new complete codes under the subcategory are below:

• F02.811 (Dementia in other diseases classified elsewhere, unspecified severity, with agitation)
• F02.818 (Dementia in other diseases classified elsewhere, unspecified severity, with other behavioral disturbance)

The new dementia codes don’t stop there, however. As with the F01.- category, ICD-10-CM 2023 introduces new codes for F02.- that will require you to specify the following elements of the patient’s care:

• Severity
• Presence or absence of other disturbances

Note the similarities to new F01.- codes as you review some of the new F02.- codes below:

• F02.82 (Dementia in other diseases classified elsewhere, unspecified severity, with psychotic disturbance)
• F02.A11 (Dementia in other diseases classified elsewhere, mild, with agitation)
• F02.B18 (Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance)
• F02.B4 (Dementia in other diseases classified elsewhere, moderate, with anxiety)
• F02.C0 (Dementia in other diseases classified elsewhere, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety)
• F02.C3 (Dementia in other diseases classified elsewhere, severe, with mood disturbance)

Apply Same Concept to Unspecified Dementia Dx

There will also be several changes and additions to F03.- (Unspecified dementia) in ICD-10-CM 2023. If you’ve got the hang of the new codes above, then you can master the F03.- updates quickly, too.

The new code set will change F03.91 (Unspecified dementia with behavioral disturbance) to subcategory F03.91- (Unspecified dementia, unspecified severity, with behavioral disturbance).

And ICD-10-CM will add these new codes:

• F03.911 (Unspecified dementia, unspecified severity, with agitation)
• F03.918 (Unspecified dementia, unspecified severity, with other behavioral disturbance)

Additional changes to F03.- will require you to focus on these familiar concepts:

• Severity
• Presence or absence of other disturbances

Here’s a sampling of the new codes you’ll find in the F03.- code set in ICD-10-CM 2023:

• F03.92 (Unspecified dementia, unspecified severity, with psychotic disturbance)
• F03.A0 (Unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety)
• F03.A4 (Unspecified dementia, mild, with anxiety)
• F03.B11 (Unspecified dementia, moderate, with agitation)
• F03.B3 (Unspecified dementia, moderate, with mood disturbance)
• F03.C18 (Unspecified dementia, severe, with other behavioral disturbance)

Don’t Miss These Dementia Guideline Additions

ICD-10-CM Official Guidelines for 2023 will also add an additional section devoted to dementia. New Section I.C.5.d states, “Selection of the appropriate severity level requires the provider’s clinical judgment and codes should be assigned only on the basis of provider documentation … unless otherwise instructed by the classification. If the documentation does not provide information about the severity of the dementia, assign the appropriate code for unspecified severity.”

The potential challenge with this is the provider who, as the instructions state, will need to use their clinical judgment and clearly document the severity level. However, the addition of codes like F01.53 (Vascular dementia, unspecified severity, with mood disorder) and F03.94 (Unspecified dementia, unspecified severity, with anxiety) will help you report a patient’s condition when that information is not known.

Coding alert: Watch for notes within the code set, as well. “There are some Excludes1 notes sprinkled throughout the new dementia codes to which coders should pay attention,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

For example, under F01.A-, you’ll find an Excludes1 note for “mild neurocognitive disorder due to known physiological condition with or without behavior disturbance (F06.7-).” That particular note appears in a few different spots, so be on the lookout. Mild cognitive disorders are common and don’t always mean dementia. Diabetes, high blood pressure, recent stroke, and more can cause cognitive impairment. In these instances, you’d use a code from new subcategory F06.7- (Mild neurocognitive disorder due to known physiological condition) rather than one of the aforementioned dementia codes.

Also, “‘Use additional code, if applicable, to identify wandering in vascular dementia (Z91.83)’ pops up in multiple places, such as under F01.518,” Moore adds. Wandering is a common symptom of dementia, and one that isn’t covered in the new codes, so it’s important to code these details where applicable.