Resolved 2023 Dementia ICD10CM

[ShaylaS_64520]

Shayla Suleiman CPC
The new codes for dementia are combo codes. My place of work is asking the coders to add anxiety code separately as well as the combo dementia code with anxiety. Has anyone else had this issue?
Is this not over coding?

 

[Lori]

Perhaps the payer has specific rules but generally, it is not allowed as you do not code a diagnosis twice so the combo code would be used.

Reporting the Same Diagnosis Code More Than Once:
Each unique ICD-10-CM diagnosis code may be reported only once per encounter.
This also applies to bilateral conditions when there are no distinct codes identifying laterally or two different conditions classified to the same ICD-10-CM diagnosis code.

Unspecified dementia F03-​

Applicable To

• Major neurocognitive disorder NOS
• Presenile dementia NOS
• Presenile psychosis NOS
• Primary degenerative dementia NOS
• Senile dementia NOS
• Senile dementia depressed or paranoid type
• Senile psychosis NOS

Type 1 Excludes

• senility NOS (R41.81)

Type 2 Excludes

• mild memory disturbance due to known physiological condition (F06.8)
• senile dementia with delirium or acute confusional state (F05)

Clinical Information

• A condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems. Symptoms may also include personality changes and emotional problems. There are many causes of dementia, including alzheimer disease, brain cancer, and brain injury. Dementia usually gets worse over time.
• An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness.
• Dementia is the name for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there. Memory loss is a common symptom of dementia. However, memory loss by itself does not mean you have dementia. People with dementia have serious problems with two or more brain functions, such as memory and language. Although dementia is common in very elderly people, it is not part of normal aging.many different diseases can cause dementia, including alzheimer's disease and stroke. Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve symptoms or slow down the disease.
• Loss of intellectual abilities in an elderly person, interfering with this person's activities.
• Loss of intellectual abilities interfering with an individual's social and occupational functions. Causes include alzheimer's disease, brain injuries, brain tumors, and vascular disorders.
• Loss of intellectual functions such as memory, learning, reasoning, problem solving, and abstract thinking while vegetative functions remain intact.

Codes

• F03 Unspecified dementia
  • F03.9 Unspecified dementia, unspecified severity
    • F03.90 …… without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    • F03.91 Unspecified dementia, unspecified severity, with behavioral disturbance
      • F03.911 Unspecified dementia, unspecified severity, with agitation
      • F03.918 Unspecified dementia, unspecified severity, with other behavioral disturbance
    • F03.92 …… with psychotic disturbance
    • F03.93 …… with mood disturbance
    • F03.94 …… with anxiety
  • F03.A Unspecified dementia, mild
    • F03.A0 …… without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    • F03.A1 Unspecified dementia, mild, with behavioral disturbance
      • F03.A11 Unspecified dementia, mild, with agitation
      • F03.A18 Unspecified dementia, mild, with other behavioral disturbance
    • F03.A2 …… with psychotic disturbance
    • F03.A3 …… with mood disturbance
    • F03.A4 …… with anxiety
  • F03.B Unspecified dementia, moderate
    • F03.B0 …… without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    • F03.B1 Unspecified dementia, moderate, with behavioral disturbance
      • F03.B11 Unspecified dementia, moderate, with agitation
      • F03.B18 Unspecified dementia, moderate, with other behavioral disturbance
    • F03.B2 …… with psychotic disturbance
    • F03.B3 …… with mood disturbance
    • F03.B4 …… with anxiety
  • F03.C Unspecified dementia, severe
    • F03.C0 …… without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    • F03.C1 Unspecified dementia, severe, with behavioral disturbance
      • F03.C11 Unspecified dementia, severe, with agitation
      • F03.C18 Unspecified dementia, severe, with other behavioral disturbance
    • F03.C2 …… with psychotic disturbance
    • F03.C3 …… with mood disturbance
    • F03.C4 …… with anxiety

https://www.nhpco.org/wp-content/uploads/Dementia_ICD10_Fact_Sheet.pdf

Please see this Denemtia thread for more info:

Resource - Dementia

Unspecified dementia F03- Applicable To Major neurocognitive disorder NOS Presenile dementia NOS Presenile psychosis NOS Primary degenerative dementia NOS Senile dementia NOS Senile dementia depressed or paranoid type Senile psychosis NOS Type 1 Excludes senility NOS (R41.81) Type 2...

www.cco.community

 

[GerardS_36106]

Shayla Suleiman CPC
The new codes for dementia are combo codes. My place of work is asking the coders to add anxiety code separately as well as the combo dementia code with anxiety. Has anyone else had this issue?
Is this not over coding?

Are you working in long term care? If so, the reason for this is that the MDS does not always recognize combo code for section I sometimes. Often too this is the case for Lewy Body dementia, you will often separate out the codes because the MDS does not recognize it as both dementia and parkisons. I work in long term care and have noticed this as we work on MDS for residents.

 

[Alicia]

There is a reason for this Shayla. The systems are not caught up with the new codes yet. Denials are even coming back d/t the CPT codes. Go ahead and use them and hopefully they will get it all fixed by March. "Hopeful"

 

[ShaylaS_64520]

There is a reason for this Shayla. The systems are not caught up with the new codes yet. Denials are even coming back d/t the CPT codes. Go ahead and use them and hopefully they will get it all fixed by March. "Hopeful"

Thank you so much

 

[ShaylaS_64520]

Are you working in long term care? If so, the reason for this is that the MDS does not always recognize combo code for section I sometimes. Often too this is the case for Lewy Body dementia, you will often separate out the codes because the MDS does not recognize it as both dementia and parkisons. I work in long term care and have noticed this as we work on MDS for residents.

Yes SNF coding
Thank you