Dementia w/Behavioral disturbance

[randijelinek]

I am coding Demential w/Behavioral disturbance (294.11) but the ICD-9 book states to coed first any underlying physical condition. The physician is unsure what is causing the patient's dementia. I have had this denied by Wellmark when there is not a underlying condition listed first. This patient has Merit (Medicaid). I have thought about using 294.8 but that is for Dementia NOS.

Any thoughts?
Thanks for the help!

[ohn0disaster]

Technically, 294.8 is for Dementia NOS due to conditions classified elsewhere, only it doesn't ask for the code for the condition that the dementia is due to. I would just use the code for Dementia and then code the behavioral disturbance, if the doctor specified what the behavioral disturbance is. If the doctor just wrote " with behavioral disturbance", you have two choices. You can either query the physician as to what the specific disturbances are or you can use 312.9 for unspecified behavior disturbance.

Hope this helps.