Medicare Compliance & Reimbursement

New cognitive impairment, mental status codes enhance your coding accuracy.

Two of the new and revised codes of particular interest to Skilled Nursing Facility (SNF) coders focus on a patient's mental status. Learn the right way to use these codes from our experts to avoid claim delays.

1. 331.83 (Mild cognitive impairment, so stated). "With the growing aging population, the new code for cognitive impairment is good to see," Linda Martien, CPC, CPC-H, overseer of coding operations at National Healing Corp. of Boca Raton, FL, said during a recent Eli audio conference. "It was very frustrating to try to code some of the [cognitive] alteration in awareness; now we'll have this five-digit code to give us a more specific diagnosis."

Hidden asset: This new code is in the category for other cerebral degenerations (331), says Anne Cook, RHIA, of Anne Cook and Associates, Health Information Management Consultants in Marietta, GA. This category also contains Alzheimer's disease. This new code is in the Nervous System chapter of the coding manual--so the diagnosis is not just a symptom, she notes.

Proceed with caution: Physicians often use the term "mild cognitive impairment" "to describe cognitive impairment due to conditions such as head trauma, dehydration, malnutrition, late effects of strokes, etc.," Sue Bowman, RHIA, CCS, director of coding policy and compliance with the American Health Information Management Association (AHIMA), wrote in a letter to the ICD-9-CM Coordination and Maintenance Committee. "We are concerned that misapplication of the proposed code for various types of cognitive impairment would result in useless data," she said. "Physicians often document 'mild cognitive impairment' when describing cognitive impairments due to various underlying conditions."

For a therapy patient who does have mild cognitive impairment, this code would helpful explain a longer-than-average number of days in therapy, Cook says. Physicians often won't consider patients with moderate and severe cognitive impairment as good candidates for therapy at all, but the patient with mild cognitive impairment would probably still be very responsive, she says.

2. 780.97 (Altered mental status). Several requests for a new code for altered mental status inspired the addition of this code, the committee said.

Altered mental status was denoted with a five-digit code in 2006 as well, Cook says. But that code was the more general 780.99 (Other general symptoms), which included amnesia, chills, and generalized pain, among other diagnoses. The new code, still in the Symptoms, Signs, and Ill-Defined Conditions chapter, allows you to report this specific symptom.

Altered mental status may be described as a symptom of several different types of illnesses, the committee says. The underlying etiologies can include trauma, infection, neoplasm, alcohol, and drugs, as well as endocrine disorders, neurological disorders, psychiatric disorders, and renal disorders, the committee says.

A diagnosis of altered mental status may be based on reports from family or caregivers, the committee says. Acute changes from baseline mental function are important, which requires knowledge of the baseline, the committee says.

Mental status examination includes assessment of orientation, affect and mood, language, memory, judgment and insight, as well as abnormal thought content, and perception abnormalities, the committee says.

Best practice: If the specific cause for a patient's altered mental status is known, that cause should be coded, rather than listing a symptom code such as 780.97, the committee says.

Coding scenario: Your patient has been exhibiting an alteration in mental status, but you haven't been able to determine the cause. The physician diagnoses the patient with altered mental status and orders urine sent out for urinalysis.

If it turns out that the patient has a urinary tract infection (UTI) that caused the altered mental status as a side effect, you should stop reporting the altered mental status and instead code for the UTI, says Lynn Yetman, RN, MA, HCS-D, COS-C, LNC, with Reingruber & Company, St. Petersburg, FL.