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How to code for "Cognitive Impairments"

  1. #1
    Salt Lake North
    Cool How to code for "Cognitive Impairments"
    Medical Coding Books
    Hello all out there in coder land. Many of my docs see older patients. One diagnosis that I am seeing is various stages of cognitive impairment. But the ICD9 seems to only have one code for anything related to cognitive impairments which is "Mild cognitive impairment, so stated". If the doc does not state "Mild cognitive impairment" how do you code it? Any thougths, suggestions?

  2. #2
    Louisville, KY
    I'll be honest, our approach has been to request signs/symptoms. The psych testing results (e.g., "moderate cognitive impairment", etc) are really only snapshots of the patient's condition. In some instances the patient may actually carry a diagnosis of dementia or Alzheimer's, but the standardized test doesn't provide a score of "Dementia." Are you with me?

    You really have a number of choices: 1.) Ask for sign/symptoms 2.) Query for the final or definitive dx, or 3.) settling on a code like 294.9 (or similar). In the event you choose option 3, I'd be sure a discussion was held with the clinical staff to make sure they were comfortable with reporting that code.

    Keep in mind that with these exams, it's a lot like doing an EKG for a patient with chest pain. The patient may indeed have a causal condition that creates the symptom (e.g., forgetfulness), but the diagnostic test, in and of itself, is incapable of providing a definitive diagnosis for us. Basically, we may end up reporting signs, symptoms and "ill-defined" conditions--or something similar--because a definitive diagnosis cannot be truly determined based on the exam findings.

    I hope this has been helpful and good luck!

  3. #3
    Salt Lake North
    Thank you Kevin, that is indeed a big help to me.

  4. Default
    Thank you several years later!

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