OASIS Alert

Published on Wed Jan 10, 2007 PDF

But beware of overuse.

A confused patient -- especially an elderly one -- could be suffering from a specific or a non-specific problem. Two new codes help you provide more information about these patients.

 Many home care patients are confused as a result of infections, particularly urinary tract infections, experts say. Other sources of confusion are Alzheimer's or other dementias; drug side effects; postoperative effects of anesthesia or pain; dehydration, or sleep deprivation, says Rena Shephard, president of RRS Consulting in San Diego.

First Look for a Specific Cause

If you know the specific cause of a patient's confusion, you should put that code in the list of diagnosis codes in M0230 or M0240, says consultant Lynn Yetman with St. Petersburg, FL-based Reingruber & Company.

Example: If the patient exhibits confusion, but also has a urinary tract infection, report the UTI code, rather than the side effect of confusion, Yetman says.

Use New Code to Support Therapy Use

ICD-9-CM code 331.83 (Mild cognitive impairment, so stated) can explain why a patient needs more than the average amount of therapy, says consultant Anne Cook, of Anne Cook and Associates, Health Information Management Consultants in Marietta, GA. So 331.83 provides useful information if used correctly.

This code fits in section 331 (Other cerebral degenerations) of the ICD-9-CM codes, Cook says. Section 331 is in the "Nervous System" chapter, not in the "Symptoms" chapter, and includes Alzheimer's disease (331.0) and frontotemporal dementias, such as Picks disease (331.11).

Heads up: Physicians often use the term "mild cognitive impairment" to describe cognitive problems resulting from many underlying diagnoses, such as head trauma or strokes, says Sue Bowman, director of coding policy and compliance with the American Health Information Management Association. Be sure there is no identified underlying disease before using 331.83.

Look for Altered Mental Status Code Change
 
In the "Symptoms, Signs and Ill-Defined Conditions" chapter of the 2006 ICD-9-CM manual, code 780.99 (Other general symptoms) included amnesia, chills and generalized pain as well as altered mental status, Cook says. Now in the 2007 codes you have a specific code -- 780.97 -- for altered mental status.

Altered mental status may be a symptom of several different kinds of illnesses, says the ICD-9-CM Coordination and Maintenance Committee. These include trauma; infection; alcohol and drug ingestion;and endocrine, renal, neurological and psychological disorders, the committee says.

You would use 780.97 if you have observed or the family has reported a change from the baseline mental functioning, but you know of no specific cause, the committee explains.

Note: For detailed coding info, order Eli's Home Health ICD-9 Alert at 1-800-874-9180.