Wiki Vasuclar Dementia

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himanib

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vascular dementia code has a line underneath that states 'code additional code for cerebral atherosclerosis 437.0'. At 290, there is a direction that says 'code first the neurological condition'. Should there be three codes total for vascular dementia? Also, according to etiology-manifestation rule doesn't atheroslcerosis code come first since it was the causal condition for dementia?
How should we code vascular dementia if it's considered a manifestation?
 
Vascular dementia

If only vascular dementia is documented, you would code 290.4X (fill in 5th digit based on documentation) and add 437.0. If a neurological condition is documented as the cause of the dementia, then you would code that condition first. For instance, if documentation states that the vascular dementia is a late effect of a previous stroke, 438.89 would supersede 290.4X.
 
The code first note is not an option, 290 code must have an underlying neurological condition listed first. The note under the 290.4 subcategory instructs to add the cerebral atherosclerosis as an additional code, so the order is spelled out for you
Neurological condition code
290.4
Cerebral atherosclerosis code
You cannot ignor the instructions in the tabular section.
 
Debra, I appreciated this information very much. I have an additional question related to CMS's CR8877 indicating that for terminal hospice diagnoses the guidelines you noted (Neurological condition first, Vascular Dementia and then possibly the atherosclerosis) will be strictly adhered to beginning this Oct. Our medical directors have concerns about the interpretation of the term "neurological condition". Many of the conditions contributing to vascular dementia are actually "vascular" in nature not "neurological". My question to you is how broadly can the term neurological condition actually be interpreted?

Contacts with CMS Provider Contact Center have not been able to clarify as "no coders" are available.
Thanks
 
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Hospice coding in CMS CR8877 tells us not to use 290.40 as a primary. Went online and found American Psychiatric Association reclassified dementia as a "neurocognitive disorder" mild or major. So does this mean vascular dementia should be coded a vascular neurocognitive disorder? Should if be coded as 438.0 or 331.9 ?
 
437.0 vs 437.1 with Vascular Dementia

When coding Vascular Dementia 290.4X the tabular indicates to use 437.0. If the patient has 437.1 would that cover the reqirement of using 437.0?
 
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