Home Health ICD-9/ICD-10 Alert

Question: We have been listing 294.11 and 294.8 when a patient is diagnosed with dementia with behavior disturbances. Are these the best diagnoses?

Answer: Codes 294.11 (Dementia in conditions classified elsewhere with behavioral disturbance) and 294.8 (Other persistent mental disorders due to conditions classified elsewhere), which includes dementia, NOS apply to behavioral and mental disturbances. However, ICD-9 guidelines direct you to only report the 294.1x codes as a secondary diagnosis and to code first any underlying physical condition such as, for example, dementia in Alzheimer's disease (331.0). The code 294.1x is a manifestation code.

Better choice: Query the physician for more details about the type of dementia, so you can choose a more specific diagnosis. The patient's symptoms (such as confused state, depression, or delusion) and your physician's documentation might lead you to code category 290 (Dementias) or to a more specific primary diagnosis such as Alzheimer's (331.0).