ICD 10 Coding Alert

Hint: Don’t forget to check documentation for behavioral disturbances.

If you need to figure out the correct diagnosis code for vascular dementia, you need to evaluate certain details of a patient’s medical history to select the correct code.

Check your understanding of this condition against this question-and-answer set to make sure your coding is in top shape.

Define Vascular Dementia

Question 1: What is vascular dementia?

Answer 1: Vascular dementia is a form of dementia caused by the lack of blood supply to the patient’s brain, which leads to brain damage resulting in loss of memory and other cognitive disorders.

Find These Two Codes

Question 2: Which ICD-10-CM codes should I report for vascular dementia?

Answer 2: You can look to the following two codes for vascular dementia:

• F01.50 (Vascular dementia without behavioral disturbance)
• F01.51 (Vascular dementia with behavioral disturbance)

You will choose between the above two codes depending on the presence or absence of behavioral disturbance. You will report F01.50 for vascular dementia without behavioral disturbance. On the other hand, you should report F01.51 when your physician diagnoses vascular dementia with aggressive, combative, or violent behavior or if any other behavioral problems co-exist with the signs and symptoms of vascular dementia.

Coding rules: When reporting a code from category F01.5- (Vascular dementia), you should code first the underlying physiological condition or sequelae of cerebrovascular disease, per the ICD-10-CM manual. For example, if the patient has vascular dementia without behavioral disturbance associated with cerebral atherosclerosis, you would report I67.2 (Cerebral atherosclerosis), followed by F01.50 on your claim.

This is similar to other conditions that are a consequence of another primary diagnosis, says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. You should report the pathophysiological entity that causes the subsequent condition first.

Search for Evidence of Other Conditions

Question 3: Do codes F01.50 and F01.51 include any other conditions?

Answer 3: Yes. Along with vascular dementia without behavioral disturbance, F01.50 also includes major neurocognitive disorder without behavioral disturbance.

Additionally, code F01.51 encompasses numerous included conditions besides vascular dementia with behavioral disturbance. These are as follows:

• Major neurocognitive disorder due to vascular disease, with behavioral disturbance
• Major neurocognitive disorder with aggressive behavior
• Major neurocognitive disorder with combative behavior
• Major neurocognitive disorder with violent behavior
• Vascular dementia with aggressive behavior
• Vascular dementia with combative behavior
• Vascular dementia with violent behavior

Don’t miss: A note under F01.51 instructs you to report an additional code, if applicable, to identify wandering in vascular dementia (Z91.83).

Know How Providers Make This Diagnosis

Question 4: How will my neurosurgeon diagnose vascular dementia?

Answer 4: Your neurosurgeon will arrive at a diagnosis of vascular dementia based upon a complete history and an evaluation of the patient’s signs and symptoms. This service will include a complete mental status examination, a complete psychiatric and medical history of the patient and family, a review of systems (ROS), and ordering and interpreting neuropsychological and other diagnostic tests such as a Folstein Mini Mental Status Examination and Geriatric Depression Scale (GDS).

Your neurosurgeon will also assess the patient for behavioral problems that co-exist with dementia.

Don’t miss: Your neurosurgeon may also order laboratory tests such as CBC, ESR, blood sugar, liver and kidney function tests, thyroid function test, and tests for vitamin B-12 or folate to rule out other causes for dementia. Your surgeon might also ask for an MRI or CT of the brain to confirm the diagnosis of vascular dementia. The surgeon might subject the patient to other tests such as echocardiography and Holter monitoring to assess the patient for stroke.

Look Out for These Symptoms

Question 5: What are some of the symptoms of vascular dementia?

Answer 5: Some of the common signs and symptoms of vascular dementia include paranoia, hallucinations, delusions, confusion, mood swings, reduced ability to perform day-to-day activities, memory loss, slurred speech, tremors, weakness in the extremities, and urinary incontinence.