Dementia presents unique challenges in accurately coding procedures, documenting care, and navigating billing complexities. Moreover, precise medical coding for dementia is essential to:
- Ensure accurate reimbursement
- Facilitate care coordination
- Effectively track disease progression
The coding and billing landscape is constantly changing. Therefore, to prevent reimbursement delays, optimize processes, and ensure timely payment for your work, it is crucial for your Neurology practice to stay updated on these changes.
For FY2023, there are significant changes in ICD-10-CM Chapter 5, focusing on Mental, Behavioral, and Neurodevelopmental Disorders. These updates specifically address dementia severity and associated behavioral disorders. As part of this expansion, there were 69 new codes added, accompanied by a new guideline.
Dementia Classifications
According to the World Health Organization, dementia is a term for several diseases that affect memory, thinking, and the ability to perform daily activities. The illness gets worse over time. Even if it is a syndrome that several diseases can cause, Alzheimer’s disease is the most common form of dementia and may contribute to 60 to 70% of cases.
The ICD-10-CM classifies dementia (categories F01, F02, and F03) based on the etiology and severity (unspecified, mild, moderate, or severe). Overall, diagnostic criteria depend on cognitive impairment, and other aspects of the clinical picture (behavior, impairment in function, increased costs, carer stress) ultimately derive from impaired cognition.
The provider’s clinical judgment is essential for accurately determining the severity level. Also, the assignment of codes should rely solely on the information documented by the provider unless the classification system instructs otherwise.
In cases where the documentation does not specify the severity of dementia, assigning the code corresponding to an unspecified severity level is appropriate.
Also, when a patient with dementia is admitted to an inpatient acute care hospital or another inpatient facility setting and their condition progresses to a higher severity level, the appropriate coding practice is to assign a single code representing the highest severity level documented during the patient’s stay.
Dementia Code Updates
The most recent guideline for reporting dementia underscores the importance of precise and comprehensive documentation by the healthcare provider.
It is crucial for the documentation to explicitly state the level of seriousness or severity of the patient’s condition. The coder must accurately encode the increased severity if the patient’s condition worsens while receiving care at the medical facility.
Here are some newly code updates classifications for dementia to identify and adequately code this condition:
*These codes require a sixth digit to ensure clinic documentation improvement.
For clinical documentation improvement (CDI) purposes, coders must add a sixth digit for each code to specify the type of behavioral disturbance. Providers need to register the kind of disturbance in their annotations so coders can adequately add the last digit to the code.
These last digits give coders an idea of the type of behavioral disturbance related to each dementia, such as agitation, psychotic or mood disturbance, or without any behavioral disturbance.
Let’s review an example!
When a patient is diagnosed with unspecified dementia, the provider must describe whether the condition is mild, moderate, or severe (F03.A1, F03.B1, F03.C1).
Providers also need to explain the disturbance type so coders can add the sixth digit properly. In this case, F03.C11 explains unspecified dementia, severe, with agitation, with aberrant motor behavior, or verbal or physical behaviors. Meanwhile, F03.C18 stands for unspecified dementia, severe, with other behavioral disturbances.
For more information, read the complete ICD-10-CM Official Guidelines for Coding and Reporting FY 2023.
At Health Prime, we can help!
The Alzheimer’s Association stated that between 2020 and 2030, 1.2 million additional direct care workers will be needed to care for the growing population of people with dementia — the most significant worker gap in the U.S.
Outsourcing some of your administrative processes, including coding, is a good idea to address this staff shortage. With over 30 years of experience working with Neurology practices, Health Prime deeply understands how to leverage technology and software. Our approach optimizes the clinical, financial, operational, and patient workflow of Neurology groups.
Learn more about optimizing your medical billing and coding to improve patient care, reduce costs and maximize revenue collection. You can reach us at [email protected]. Our team will set up a meeting to discuss how Health Prime can help you achieve your practice goals.
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