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Pulmonology Coding Alert

Reader Question:

Dementia Diagnosis

Published on Tue Jan 01, 2002

Question: When I evaluate a patient for sleep apnea who also has Alzheimers (mild to moderate), will an ICD-9 code of dementia cause the carrier to flag the claim?

Idaho Subscriber  
Answer: According to a Sept. 25, 2001, memorandum from CMS to intermediaries and carriers, contractors should not install edits that result in the automatic denial of services based solely on the ICD-9 codes for dementia. When a beneficiary with dementia has an illness or injury unrelated to his dementia, the provider should submit a claim with a primary diagnosis that most accurately reflects the need for the provided services.     

Therefore, the pulmonologist would use the more general 780.5 (sleep disturbances) until the results of a sleep study are known, or 780.53 (sleep disturbances, hypersomnia with sleep apnea). Code 331.0 (Alzheimers disease) should not be used.
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