ICD-10 Coding Guidelines for Alzheimer’s Disease

ICD-10 CODING GUIDELINES FOR ALZHEIMER’S DISEASE

Here is some information on Alzheimer’s disease, symptoms, diagnosis and the various guidelines for coding this condition effectively.

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Alzheimer’s is the most common form of dementia that causes problems with memory, thinking and behavior. Known as the 6th leading cause of death in the United States, this condition is irreversible and causes degeneration in the brain cells resulting in steady decline in memory and mental function. Reports suggest that an estimated 5.5 million Americans of all ages are living with Alzheimer's dementia in 2017. By the end of 2050, this number could rise as high as 16 million. A combination of genetic, lifestyle and environmental factors are the most potential causes that affect the brain over time. The greatest known risk-factor is increasing age, and the majority of people with Alzheimer's are aged 65 years and older. The early symptoms of this progressive brain disorder may vary according to the person, as in its early stages memory loss is very mild, but with late-stage of this disease, individuals lose the ability to carry on a conversation and respond to the environment. Detecting early symptoms of Alzheimer’s is crucial for providing appropriate care. Healthcare providers while administering different treatment modalities should have up-to-date knowledge about the latest medical billing and coding guidelines. Reporting the diagnosis with appropriate codes is equally important to ensure correct reimbursement.

Need for Early Diagnosis There are different signs and symptoms associated with this progressive brain disorder and this may vary from one person to another. Gradual deterioration in the ability to remember new pieces of information is the most common and initial symptom of this condition. Some of the other prominent symptoms include - misplacing objects, challenges in solving problems, changes in mood or personality, confusion with time/place, problems with words in speaking or writing and many more.

Undergoing Alzheimer’s screening at an early age is important, as these tests will help to identify this condition early so that an effective treatment modality can be offered. Regular screening allows physicians to identify the correct symptoms and promote adequate treatment without any further complications. Althoughthere is no specific test that confirms the presence of this brain disorder, neurologists may conduct different cognitive and brain imaging tests such as magnetic resonance imaging(MRI), computerized tomography (CT), positron emission tomography (PET) and single photon emission computed tomography (SPECT) scan to confirm whether the patient suffers from this brain disorder.

Reporting Diagnosis and Coding for Alzheimer’s disease Medicare offers coverage for screening and providing information about care planning for patients with Alzheimer’s and other cognitive impairment diseases. This may include

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ongoing hospital care, physical exam, doctor visits and several other tests. Physicians providing treatment need to report the correct diagnostic and procedural codes on the claims to ensure appropriate coverage.

While coding for Alzheimer’s, one of the major challenges is that providers often use terms such as dementia and Alzheimer's disease interchangeably, but they actually have different clinical parameters. Coders in reliable medical coding companies need to understand how to use these codes accurately to bill for Alzheimer’s and other associated conditions.

In ICD-10, the following codes are used – 

G30 - Alzheimer's disease



G30.0 – Alzheimer’s disease with early onset



G30.1 – Alzheimer’s disease with late onset



G30.8– Other Alzheimer’s disease



G30.9 – Alzheimer’s disease, unspecified

Dementia is an inherent part of the diagnosis of Alzheimer’s disease. The physician does not have to give both a diagnosis of Alzheimer’s disease and dementia in order to report both codes. As per the ICD-10-CM Alphabetic Index, the code G30.9 would be reported first followed

by

F02.81

or

F02.80

to

show

dementia

with

or

without

behavioral

disturbances.Since the codes F02.81 or F02.80 are inside slanted brackets, these are considered a manifestation of the disease and would be sequenced second as per the official guidelines for coding and reporting.

Codes for dementia are located in categories F01-F03 in ICD-10-CM. The categories available are 

F01 - vascular dementia



F02 - dementia in other diseases



F03 - unspecified dementia



F03.90 - Unspecified dementia without behavioral disturbance



F03.91: Unspecified dementia with behavioral disturbance



F05 - Delirium due to known physiological condition



F02.80 - Dementia in other diseases classified elsewhere without behavioral disturbance (Code first the underlying physiological condition)



F02.81 - Dementia in other diseases classified elsewhere with behavioral disturbance (Code first the underlying physiological disease, such as Alzheimer’s (G30.)

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

Z72.89 - Other problems related to lifestyle

Code F03.90 can be used for - senile dementia uncomplicated, pre-senile dementia uncomplicated, pre-senile dementia with delirium, pre-senile dementia with depressive features and senile dementia with depressive features. Both F03.90 and F05 should be used if the patient has pre-senile dementia with delusional features, senile dementia with delusional features and senile dementia with delirium.

With support from reliable medical coding services, implementing the combination of codes for Alzheimer’s disease and dementia can be madeeasier. Coders in a professional medical coding company keep themselves updated on the changing coding guidelines and use the correct codes, thereby avoiding claim denials.

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