Internal Medicine Coding Alert

Question: Our coder reports 294.11 and 294.8 when our physician notes dementia with behavior disturbances. Are these the best diagnoses?

Wisconsin Subscriber

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

Better choice: Query the physician for more details about the type of behavior disturbances, 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 family 290 (Dementias) or to a more specific primary diagnosis such as Alzheimer's (331.0).