Neurology & Pain Management Coding Alert

Question: One of our commercial payers denies 331.0 as a diagnosis for Alzheimer's, stating that the diagnosis is not specific enough or to the highest level of coding. What kinds of diagnoses might they expect? Alabama Subscriber

Answer: Although 331.0 (Alzheimer's disease) seems on target, the payer might also require diagnoses that further explain specific symptoms. For example, some Blue Cross/Blue Shield payers accept 780.93 (Memory loss) and Medicare accepts 331.83 (Mild cognitive impairment, so stated). Check the payer's policy to confirm possible diagnoses. Remember, however, to submit diagnoses based on your provider's documentation, not simply to fit a payer's list of requirements.