Wiki Diagnosis code F01.50 (Dementia, vascular, mixed)

[ametcalf@intermed.com]

Hello

I'm looking for some guidance with F01.50 diagnosis code as Primary. Anthem Medicare advantage is denying this on my claim as an invalid diagnosis for Primary. I'm not seeing in coding guidance where this code requires an additional code to fully describe and nothing indicating it can't be primary unless I'm missing something. Does anyone have any thoughts if this is okay to be a Primary diagnosis on a claim?

Thanks

 

[ckeeney]

There is a code first note at the beginning of the category requiring you to code first the underlying physiological condition or sequelae of cerebrovascular disease.

 

[SharonCollachi]

Medicare has disallowed certain mental health diagnoses for years as primary. For instance (try to follow their logic here), dementia itself is not treatable. However, the underlying cause is treatable, or the memory problems it creates is treatable, or the anxiety and depression that can come with it is treatable. So you can bill any of those other things as the primary diagnosis, because those are the things you are treating.