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Home Health Coding and OASIS Expert

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Make the ICD-10 Transition with Dementia Coding

Published on Tue Apr 14, 2015

Question: Your 52-year-old male patient has been diagnosed with dementia due to early-onset Alzheimer’s. The physician notes that he has been having increasing dementia and forgetfulness. He has been wandering off and leaving his home and forgetting where he is or where he is going. How would you code for these conditions in ICD-9? How would you code for them in ICD-10?

Answer: To code for this patient in ICD-9, you would list the following codes:
  • 331.0 — Alzheimer’s disease;
  • 294.11 — Dementia in conditions classified elsewhere with behavioral disturbance; and
  • V40.31 — Wandering in diseases classified elsewhere.
To code for this patient in ICD-10, you would list the following codes, says Judy Adams, RN, BSN, HCS-D, HCS-O, with Adams Home Care Consulting in Asheville, N.C.:
  • G30.0 — Alzheimer’s disease with early onset;
  • F02.81 — Dementia, in Alzheimer’s disease; and 
  • Z91.83 — Wandering in diseases classified elsewhere.
Your coding for this patient will differ slightly in ICD-10, but the logic for assigning the codes remains much the same.
 
In ICD-9, to find the correct code for your patient’s Alzheimer’s disease, you’ll look in the Alphabetic Index under Alzheimer’s, Dementia, with behavioral disturbance. While ICD-9 doesn’t include a separate code to indicate that the patient’s Alzheimer’s disease is early onset, you can report this with ICD-10. In the ICD-10 Alphabetic Index, you would reference Disease, Alzheimer’s, early onset with behavioral disturbance. Early onset Alzheimer’s begins in middle age before the age of 65.
 
A recent response to a question to Coding Clinic states that Alzheimer’s and dementia are paired codes so that even if the physician just states that a patient has Alzheimer’s, you will still code the dementia. An earlier request for information indicated that the physician has to identify that the patient has behaviors related to the dementia. Those behaviors may be aggressive behavior, combative behavior, or violent behavior and wandering off.
 
These codes require mandatory sequencing, Adams says. Sequence the etiology (Alzheimer’s disease) first and the manifestation (dementia) second. The Alphabetic Index provides the following documentation:
 
For ICD-9: Alzheimer’s, dementia, with behavioral disturbance 331.0 [294.11]
 
For ICD-10: Alzheimer’s, early onset, with behavioral disturbance G30.0 [F02.81]
 
The use of the brackets in the Index indicates a manifestation code.
 
Notes in the Tabular List at the 331.0 and G30 categories instruct you to use an additional code to identify dementia with behavioral disturbance (294.11 or F02.81). At the 294.11 or F02 category, the note states to code first the underlying physiological condition. 
 
You’ll code for this patient’s dementia with behavioral disturbance because of the documentation that he is wandering off. 
 
At code 294.11 and F02.81, a note states to use additional code, if applicable, to identify wandering in conditions classified elsewhere (V40.31 or Z91.83). This code further specifies the patient’s behavioral disturbance as wandering off.

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