Psych diagnosis with medical manifestation

dkrisak

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We have a psychiatric unit which needs a psychiatric diagnosis in order to meet medical necessity for the stay. When the patient's final diagnosis is dementia with behavioral disturbance due to Parkinson's Disease, we are directed to code the manifestation first. We submitted the bill to the insurance carrier with the G20 first then the dementia code F039. One of our insurance carriers has denied the claim because they want the psych diagnosis first. But our coding guidelines tell us to code the medical manifestation first. Have you come across this issue? How do we handle this? Are we able to flip the order of these codes?
 
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We have a psychiatric unit which needs a psychiatric diagnosis in order to meet medical necessity for the stay. When the patient's final diagnosis is dementia with behavioral disturbance due to Parkinson's Disease, we are directed to code the manifestation first. We submitted the bill to the insurance carrier with the G20 first then the dementia code F039. One of our insurance carriers has denied the claim because they want the psych diagnosis first. But our coding guidelines tell us to code the medical manifestation first. Have you come across this issue? How do we handle this? Are we able to flip the order of these codes?

I think I may have an answer for you.
First thing, F03.9 is for unspecified dementia, not a manifestation code. Also, the dementia IS specified; "with behavioral disturbance" and "due to Parkinson's."

I looked up "dementia>due to>Parkinson's disease and got G20 [F02.80]."
F02.80 is Dementia in other diseases classified elsewhere without behavioral disturbance, but F02.81 is Dementia in other diseases classified elsewhere with behavioral disturbance (both of these are manifestation codes). So I'd say the F02.81 would be the manifestation code you're looking for and the instructions for that code say "Code first the underlying physiological condition... Parkinson's G20".

So in this case it would get coded as G20, F02.81.

This is from CMS:
Code First/Use Additional Code notes (etiology/manifestation paired codes)
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.

In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/ manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition.
 
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