Wiki GUIDE Dementia Program Question

[wjbruton]

Hi -
I am not sure if this would need to be posted here or under a different specialty. I wasn't sure if anyone had experience with coding CMS GUIDE patients. My job has recently become a GUIDE participant and there have been a lot of bumps in the road as far as getting reimbursed. We have been splitting the claim, putting the assessment on one with all corresponding ICD 10 codes, then on another the G Code for the correct GUIDE tier along with the ICD 10 dementia codes. Also, putting the GUIDE code at the first day of the month that the pt was seen. I want to make sure we are interpreting the guidelines correctly or if anyone has had success in getting reimbursed from the program

 

[TThivierge]

Hello WJBurton,
Well I can tell you not to use Z dx codes first on claim such as Z87.820 TBI. The provider needs to document the Dementia problem/describe it. Is there memory loss, wandering, hearing loss and if other chronic disease linked or add to Dementia dx.. Add this dx code if extra illness. Document pt s age of start getting dementia.. ..late or early onset BEFORE age 65 then add dx . Document behaviors or depression or malnutrition as example. Here are some dx code blocks to check related to Dementia G31.84, mild cognitive impairment see dx R41 blocks. and check out dx block of G31 and F02 and F03 difference just ensure provider add matching description in notations for the day. Dx F01.5 Vascular Dementia, Frontotemporal Dementia G31.09 Alcoholic Dementia F01.97. Alzheimer early G30 are types of mental illness. Oh yes the HCC dx are for dx blocks F01-F03 & dx G23-G32 score is 52. There is no HCC score for dx R90 or R41. If pt. suffers with one of the 10 chronic conditions or Forever Diseases add it.
I hope this data helps you!
Lady T