MDS Alert
Learn These Dementia Diagnosis Code Changes
Hint: You’ll have new options for reporting severity and agitation. The ICD-10-CM codes going into effect Oct. 1, 2022, will provide many more options for documenting various forms of dementia. In fact, there are approximately 70 new codes addressing dementia! Find out more this double-length article for advice on which diagnosis codes you should get to know now in preparation for coding vascular dementia, dementia in other diseases, and unspecified dementia come October. Explore More Specific Dementia Coding Options Right now, in 2022, the ICD-10 codes available to document dementia — F01.50/ F01.51 (Vascular dementia without/with behavioral disturbance), F02.80/F02.81 (Dementia in other diseases classified elsewhere without/with behavioral disturbance), and F03.90/F03.91 (Unspecified dementia without/with behavioral disturbance) — 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. Condition refresher: Dementia is a chronic or persistent disorder of mental processes marked by memory loss, personality changes, and impaired reasoning. ICD-10 defines vascular dementia as being the result of infarction of the brain due to vascular disease, including hypertensive cerebrovascular disease. According to 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.” ICD-10 2023 converted the code F01.51 (Vascular dementia, unspecified severity, with behavioral disturbance) to parent. Then, ICD-10 added these new codes under the parent: ICD-10 2023 also adds other new codes for vascular dementia, which will ask you to clarify these elements of the patient’s condition: Here’s a sampling — an incomplete list — of the new codes you’ll find in the F01.- code set in ICD-10 2023. Understand the Broad Significance Expanding the dementia codes to this extent will likely have a positive ripple effect on everyone involved. Providers “can better determine appropriate screenings or treatment. Also, it will help avoid guesswork and allow providers to quickly assess trauma, side effects of medication, or other reversible causes of similar symptoms,” Tierney says. “Documenting any condition that affects the provider’s medical decision making process at every encounter can improve communication between facilities, and allows for better care of the patient,” she continues. Instructions: ICD-10-CM Official Guidelines for 2023 will also have an additional section devoted to dementia. New section I.C.5.d says, “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 there is currently no clinical definition for mild, moderate, or severe dementia. The provider, as the instructions state, will need to use their clinical judgment and clearly document the reasoning behind that judgment in the notes. However, the addition of codes like F01.53 (Vascular dementia, unspecified severity, with mood disturbance) or F03.94 (Unspecified dementia, unspecified severity, with anxiety) will help providers and coders report a patient’s condition before that information is known. Coding alert: “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. For example, 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 code to F06.7- rather than one of the aforementioned dementia codes. Important: “’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. Look for These New Codes to Report Dementia in Other Diseases ICD-10 2023 will also bump up the total number of codes you could use in order to diagnose dementia in other diseases classified elsewhere, which you’ll find under F02.- (Dementia in other diseases classified elsewhere). Converted to parent: F02.81 (Dementia in other diseases classified elsewhere with behavioral disturbance) Then, ICD-10 added these new codes under the parent: The new dementia codes don’t stop there, however. ICD-10 2023 introduces new codes that will require you to specify the following elements of the patient’s care: Here’s a sampling of the new codes you’ll find in the F02.- code set in ICD-10 2023. (This is not a complete list.) Pocket Knowledge of These More Specific Options There will also be several changes and additions to the F03.- (Unspecified dementia) code set in ICD-10 2023. The new code book will introduce converted to parent code F03.91 (Unspecified dementia with behavioral disturbance). Then, ICD-10 added these new codes under the new parent: The new unspecified dementia codes don’t stop there, however. ICD-10 2023 introduces new codes that will require you to specify the following elements of the patient’s care: Here’s a sampling of the new codes you’ll find in the F03.- code set in ICD-10 2023. (This is not a complete list.)
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