Psychiatry Coding & Reimbursement Alert

Published on Tue Nov 17, 2015 PDF

Question: In ICD-9, we used to use the 290.x series when the diagnosis was of senile dementia, and we used the 294.1x or 294.2x series for dementia with underlying cause or no specified cause attributed. How do we report dementia under the ICD-10 code set?

Michigan Subscriber

Answer: Your coding for reporting dementia in ICD-10 is very similar to the way you reported the condition in ICD-9. You will have to look whether or not your clinician has attributed the dementia to any particular cause as this affects your code choice. You should also look for the presence of behavioral disturbances such as delirium, delusion, depression, etc. as these too affect your code choice.

As you have pointed out, we used to use the 294.1x series of codes when the dementia was associated with an underlying disease process such as Alzheimer’s, epilepsy, multiple sclerosis, or any of the other physical conditions listed in the “code first” note under 294.1x code series. When reporting this under ICD-10 codes, you will have to report from these two codes depending on presence or absence of other behavioral problems:

• F02.80 (Dementiain other diseases classified elsewhere without behavioral disturbance)
• F02.81 (Dementia in other diseases classified elsewhere with behavioral disturbance).

You will need to code the etiology or the underlying condition first and then report F02.80/ F02.81. For instance, if a patient has dementia that is associated with Parkinson’s disease, then you will have to report the Parkinson’s disease with G20 and then, depending on the presence or absence of other behavioral problems, report either F02.80 or F02.81 for the dementia.

When the dementia did not have any specified cause or was unspecified itself, you used the 294.2x series of codes under ICD-9. These codes crossover to the following two codes again depending on the presence or absence of other behavioral problems:

• F03.90 (Unspecified dementia without behavioral disturbance)
• F03.91 (Unspecifieddementia with behavioral disturbance)

For senile dementia, you had the 290.x series of codes that you would use in ICD-9. However, in ICD-10, there is no separate set of codes to report senile dementia with the specificity that you had in ICD-9. The codes in the 290.x series also crossover to either F03.90 or F03.91 again depending on the presence or absence of behavioral problems. For instance, uncomplicated presenile dementia that you would report with 290.10 can be reported with F03.90 while you report presenile dementia with delusional features (290.12) with F03.91.