Dementia

[dukemell]

Dementia coding since the Icd-10 changes 10-1-22. CMS is looking into the overuse of antipsychotic drugs by nursing homes. Since 10-1-22 the coding guidelines state that dementia with psychosis, anxiety, mood D/O, agitation & behaviors can be combined as a causal relationship. Our Psych providers want the anxiety, psychosis & mood d/o coded separately. In the past if you had dementia & agitation, you didn't code the agitation & changed the dementia code to "with behaviors". Does it seem that the way to "fix" this is to have the providers document psychosis not related to dementia? Code the dementia without combining with the psychosis & code the psychosis?

 

[TThivierge]

Hi Dukemell,
Yes Dementia coding has been given more description of mild, moderate, severe and with agitation in new ICD10 year 2023 manual. I d suggest your provider use this in their documentation for the patient's suffering with Dementia depending on illness symptoms. Also add F06.7 dx may describe more of the patient s problem if supported with ongoing illness.. Id just use the F03.C11 Dementia with agitation instead of coding separately. If pt suffers too with psychosis dx F60 or dx F20 add it with supported description. they are not Excludes 1 rules with Dementia dx codes of F03 or G34 Mild neurocognitive DO.
Well I hope this tidbit of data helps you
Lady T

 

[thomas7331]

Dementia coding since the Icd-10 changes 10-1-22. CMS is looking into the overuse of antipsychotic drugs by nursing homes. Since 10-1-22 the coding guidelines state that dementia with psychosis, anxiety, mood D/O, agitation & behaviors can be combined as a causal relationship. Our Psych providers want the anxiety, psychosis & mood d/o coded separately. In the past if you had dementia & agitation, you didn't code the agitation & changed the dementia code to "with behaviors". Does it seem that the way to "fix" this is to have the providers document psychosis not related to dementia? Code the dementia without combining with the psychosis & code the psychosis?

You're correct, many of the behavioral disorders are linked in ICD-10 by the 'with' term which by guidelines requires you to presume a causal relationship. So when that term appears in the index, they can only be coded separately when the provider specifically documents that they are unrelated to the dementia.

I'm not sure why the providers feel the need to report them separately simply because they've heard that Medicare is looking into drug usage. The combined code reports the correct information. If the coding system is inadequate for getting the necessary information to Medicare regarding the use of the drugs, Medicare will review the records for the information they need, and/or request a code revision from ICD-10 in the event that the require it. The providers shouldn't be concerned about this, and they could potentially cause more problems by trying to manipulate the information that's being reported. They should document the patients' conditions according to their best clinical assessment and these should then be coded and reported correctly according to guidelines.