Wiki TBI (S06.-) and Dementia (F02)

[ckeeney]

I am in a dilemma. We are a behavioral health facility and often the medical condition documented as cause of the dementia is a (old) TBI. I interpreted the dementia as sequela/late effect, however although not specifically indicated as not a principal diagnosis, we have a payer who is consistently denying claims with the TBI 7th character "S" listed first and the category F02 code listed second stating sequela cannot be the principal code.

The question is would the dementia be a sequela/late effect or would these visits fall under "A" or "D" for the 7th character on the TBI? Our providers are often seeing these clients after the acute phase has passed (sometimes by years) and are treating the dementia.

 

[amyllaird]

Does it state in the notes that the dementia is due to or related to the TBI?

 

[ckeeney]

Does it state in the notes that the dementia is due to or related to the TBI?

Yes. My question has more to do with whether or not to code the TBI as subsequent treatment or sequela. With the F02 code dementia due to, the underlying cause must be coded first, thus the TBI. I am having problems with the guideline that states to code the sequela first then the TBI. Therefore, I am wondering whether the TBI, even though it occurred years ago, would be coded as subsequent and not sequela.