Neurology & Pain Management Coding Alert

Question: I-ve read that differences exist between delirium, dementia and sundowning. What is the correct diagnosis for sundowning?


Mississippi Subscriber

Answer: ICD-9 does not include a code specifically for sundowning, the term for evening agitation and confusion seen in Alzheimer's patients -- probably partly because scientists have not determined what causes the syndrome. Scientists do say, however, that sundowning is more than just dementia. Sundowning really is delirium most often superimposed on dementia.

Because of this, choose your diagnosis based on the patient's specific brain disease.

Example: Report 331.0 (Alzheimer's disease) for an Alzheimer's patient with the most appropriate dementia or delirium diagnosis. Dementia coding options could include 294.10 (Dementia in conditions classified elsewhere without behavioral disturbance), 294.11 (Dementia in conditions classified elsewhere with behavioral disturbance), 294.8 (Other persistent mental disorders due to conditions classified elsewhere) or 290.x (Dementias).
 
Delirium diagnosis options could include 780.09 (Alteration of consciousness; other), 293.0 (Delirium due to conditions classified elsewhere) or 293.89 (Other specified transient mental disorders due to conditions classified elsewhere; other).

Talk with your neurologist to determine the most appropriate diagnoses for each patient.