Primary Care Coding Alert

Hint: Check for upward of 70 new codes.

ICD-10 2023 will make significant changes to ICD-10 dementia coding by adding approximately 70 new codes that address dementia. Each classification will go from having only two codes to having approximately 25. Here’s a breakdown of what you can expect to use when ICD-10 2023 becomes effective starting Oct. 1, 2022.

Ensure Provider Documentation Includes Symptom Details

The billable codes available in ICD-10 2022 — 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.

The codes: ICD-10 2023 will offer additional codes that each represent unspecified severity paired with a related symptom. The F02.- (Dementia in other diseases classified elsewhere) and F03.- categories (Unspecified dementia) will expand in the same way as F01.- (Vascular dementia), which will look like this, effective October 1, 2022:

• F01.511 (Vascular dementia, unspecified severity, with agitation)
• F01.518 (Vascular dementia, unspecified severity, with other behavioral disturbance)
• F01.52 (Vascular dementia, unspecified severity, with psychotic disturbance)
• F01.53 (Vascular dementia, unspecified severity, with mood disturbance)
• F01.54 (Vascular dementia, unspecified severity, with anxiety)

ICD-10 will break things down even more. You’ll see three new code families within each of F01.-, F02.- and F03.-, and each of those new code families, representing a level of severity, will be paired with a related symptom, almost identical to the breakdown of F01.5- above. For example, the three new families in F01.- will be:

• F01.A- (Vascular dementia, mild)
• F01.B- (Vascular dementia, moderate)
• F01.C- (Vascular dementia, severe)

The mild, moderate, and severe classifications will each break out into six specific areas. Here’s an example, using the mild vascular dementia codes:

• F01.A0 (Vascular dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety)
• F01.A11 (Vascular dementia, mild, with agitation)
• F01.A18 (Vascular dementia, mild, with other behavioral disturbance)
• F01.A2 (Vascular dementia, mild, with psychotic disturbance)
• F01.A3 (Vascular dementia, mild, with mood disturbance)
• F01.A4 (Vascular dementia, mild, with anxiety)

Why These Codes Are Significant

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,” says Tierney. “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 disorder) 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.

Also, “’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.