June is Alzheimer’s & Brain Awareness Month!
What is Alzheimer’s disease?
Alzheimer’s is a progressive neurodegenerative disease that causes multifaceted changes in the brain following cell damage which destroys memory, mental function, cognitive skills, and motor skills and affects the daily living and activities of those plagued with the disease. Per the Alzheimer’s Association, more than six million Americans are living with Alzheimer’s. The disease is noted to be more deadly than such cancers as breast and prostate combined.
In the disease process of Alzheimer’s, the brain cells degenerate and die, leading to dementia and a decline in memory and mental function. Patients become suspicious and aggressive with their family, caregivers and friends. It is the most common cause of dementia and accounts for over 60-80% of the cases, Per the Alzheimer’s Association. The progressive disease typically begins in patients 65 years and older, but it can affect people under 65 with “early onset of Alzheimer’s disease”.
This blog post will discuss Alzheimer’s, the role dementia places, and documenting and coding the disease for physicians.
Alzheimer’s Disease and Dementia coding
Per ICD-10, certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition to be sequenced first, if applicable, followed by the manifestation. Wherever such a combination exists, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code.
These instructional notes indicate the proper sequencing order of the codes and etiology followed by manifestation. When “diseases classified elsewhere” is not listed as part of your manifestation code, you will follow the “use additional code” note at the bottom of the etiology code and the “code first” note at the bottom of the manifestation code.
Dementia is an integral part of the diagnosis of Alzheimer’s disease. The physician does not have to give both a diagnosis of Alzheimer’s disease and dementia to report both codes; coding guidelines and sequencing of the codes should be followed when assigning the diagnosis codes. In addition to the sequencing of diagnosis codes, it is also vital to code the diagnosis codes to the highest level of specificity. Reviewing documentation is imperative for selecting the correct code, ex: G30.0 Alzheimer’s disease with “early onset” vs G30.1 Alzheimer’s disease with “late onset”. The physician or APP should be queried for clarification if documentation is unclear or ambiguous.
ICD-10-CM Alphabetic Index:
- G30.9 would be reported first, followed by F02.811 or F02.80 to show dementia with or without behavioral disturbances.
- Since the codes F02.80 and F02.811 are in brackets, these are considered a manifestation of the disease and would be sequenced second
Parent Code Notes: G30
Includes: Alzheimer’s dementia senile and presenile forms
Excludes1: senile degeneration of brain NEC (G31.1)
senile dementia NOS (F03)
senility NOS (R41.81)
Use additional code, if applicable, to identify:
delirium, if applicable (F05)
dementia with anxiety (F02.84, F02.A4, F02.B4, F02.C4)
dementia with behavioral disturbance (F02.81-, F02.A1-, F02.B1-, F02.C1-)
dementia with mood disturbance (F02.83, F02.A3, F02.B3, F02.C3)
dementia with psychotic disturbance (F02.82, F02.A2, F02.B2, F02.C2)
dementia without behavioral disturbance (F02.80, F02.A0, F02.B0, F02.C0)
mild neurocognitive disorder due to known physiological condition (F06.7-)
Advanced Care Planning
Providers will often discuss end-of-life decisions with the patients and family members, as the disease tends to become progressive and aggressive over time, not allowing the patient to make decisions regarding their care to providers and family members. In our prior blog post on “Documenting & Coding ACP”, I discuss the uncomfortable and challenging situation of having the ACP conversation. Still, providers need to have the family sign the required documentation.
How SDOH affects Alzheimer’s
Per the Alzheimer’s Association, older Black Americans are about twice as likely to have Alzheimer’s or other dementias as older Whites. Older Hispanics are about one and one-half times as likely to have Alzheimer’s or other dementias as older Whites. This is often due to poor access to proper healthcare, resources and early testing, factors of social determinants of health. SDOHs are defined as economic and social conditions that influence the health of people and communities. Examples may include food, housing insecurity, education and employment. These conditions tend to have the most critical impact on people’s health, well-being, and quality of life.
Documentation of other social and economic factors (Social Determinants of Health) is also vital for code assignment and the medical necessity and continued treatment of the patient’s condition.
Documentation continues to play a crucial role in identifying and combating SDOH needs that affect their patient population. Providers should report the conditions by utilizing the ICD-10-CM codes Z55-Z65 (“Z codes”) found in Chapter 21 (Z00-Z99, Factors influencing health status and contact with health services). These codes help identify the insurance companies’ nonmedical factors that may affect a patient’s health status.
Alzheimer’s disease is not only hard on the patient but also hard on the family and caregivers. Many tend to mourn the loss of what “used to be”. Caregivers work around the clock caring for the patients. But they must collaborate with the care team of physicians, social workers, caseworkers, and others involved in the patient’s care.
There are support groups for families and caregivers. The Alzheimer’s Foundation of America (AFA) have a great online resource page for caregivers, and there is also an AFA helpline available seven days a week.
- Webchat @ ALZFDN.ORG
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