Wiki Dementia Diagnosis Codes

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Kimberl1983

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Medicare came out with a guideline for using diagnosis codes 290-319 as primary codes on claims. I cannot seem to find anything about this and I have a doctor asking how to code alcohol induced dementia since he cannot use the 291.2 as his primary code. Is anyone familiar with this and can help me out please?

Thanks! :)
 
If the condition is alcohol induced then isn't this a form of poisoning by alcohol? If so then follow the poisoning guidelines. I would need the provider to be clear on whether this is considered poisoning.
 
The doctor states it is due to years of alcohol abuse. I thought that maybe you could use 305.00 + 291.2 but I do not think 305.00 can be a primary code.
 
291.2 can be a primary dx code as can 305.00, however I do not think you would code both unless the patient is currently abusing alcohol. the 291.2 does not require a code for the alcohol abuse. I have seen no directive regarding the use of 291.2 as a primary dx code. there is nothing in the coding gudelines regarding this. Noiw having said this Medicare could deny the claim if you are nbot a mental health provider as that code is in the Mental heal section. But it is an allowable primary dx code from icd-9 cm coding guidelines.
 
Thank you for your response Debra, I really appreciate it! My practice is geriatrics and palliative medicine so Medicare constantly denies those codes, that's why I'm having such a hard time because if the patient was not seen or does not have any other diagnosis, what do I use if they are going to kick back my claim. Its frustrating sometimes.
 
there is not anything you can do, the patient needs to be referred to a mental/behavior practitioner. If you can prove that your service area is underserved for this specialty, and you need to find out from Medicare what that would take, then they may pay your claims in the future but usually will cut the expected reimbursement in half. If the main reason for the encounter is pallitive treatment, then use the V code for pallitive care first listed but the documentation must clearly support this as the reason for the encounter
 
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