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CODING ALERT

Coding dementia’s most common form: Alzheimer’s

By Therese M. Jorwic, MPH, RHIA, CCS, CCS-P

Alzheimer’s disease is the most common type of dementia.

It’s not a normal part of the aging process, but the risk of getting it becomes greater as people get older. In fact, every five years after age 65, the risk doubles.

Specifically, it affects about 5.2 million people, and of those, 44% are age 75-84 and 46% are 85 or older.

What Alzheimer’s does is form plaques and tangles within the brain that cause the nerve cells to lose connection. The plaques are tiny clumps of protein called beta amyloid peptide, and the tangles are twisted strands made up of a protein called tau.

The brain tries to get rid of the proteins and in doing so becomes inflamed and damaged. Then the cells start to die and eventually the brain shuts down.

The damage usually starts in the area of the brain that affects learning, so one of the first symptoms is difficulty learning new information.

As the disease advances, the patient becomes disoriented and has mood changes, confusion, and suspicion. There can be anxiety and aggression as well as difficulty walking, speaking, and swallowing. Often the patient doesn’t sleep at night.

Risk factors with question marks

The causes of Alzheimer’s are not clear.

Family history of the disease poses the highest risk.

African-Americans are two times more likely to have it than whites, and for Hispanics the risk is even greater.

Lifestyle factors such as lack of exercise and smoking may be risk factors as well.

In the 1960s, aluminum in pots and pans and antiperspirants was thought to cause it, though that theory has since been abandoned.

There is no cure for the disease, but there are two types of drugs that treat its symptoms.

One is cholinesterase inhibitors such as Aricept, Exelon, Razadyne, and Cognex, which treat memory loss and confusion. The other is Memantine, or Namenda, for moderate to severe Alzheimer’s.

Though there is significant research going on, treatments are still limited. They lessen or stabilize the symptoms for a while, but they don’t stop the damage.

The codes start at 331.0

As for ICD-9-CM coding, go to the chapter on diseases of the nervous system and sense organs. The category is 331, which covers other cerebral degenerations, and the code for Alzheimer’s only – no dementia – which is a rare situation.

If there is dementia – and there almost always is – use a second code to identify it.

Dementia isn’t a specific disease but a group of symptoms that affect intellectual and social abilities. The codes are found in the chapter on mental and behavioral disorders.

For dementia in conditions classified elsewhere, the code is 294.1x. If the dementia includes behavioral disturbances, the code is 294.10. If there are no behavioral issues, it’s 294.11.

The notes at 294.1 say to code the underlying physical condition first, and they list diseases such as Alzheimer’s, multiple sclerosis, Parkinson’s disease, syphilis, and so on.

It’s worth mentioning that codes 294.10 and 294.11 are italicized, which means they can’t be coded first but have to appear as additional codes. Thus, the Alzheimer’s (or Parkinson’s disease or whatever) gets coded first, and the 294.xx code comes second.

At the onset of Alzheimer’s, the patient may be the proverbial sweet old lady – confused but having no behavior disturbance such as aggression – and the code then would be 294.10. But as the condition worsens and the behavior changes, the 294.11 code applies.

Finally, there is a note under 294.11 that says to use the relatively new V40.31 code if wandering is present.

More specificity with ICD-10

How will ICD-10 code Alzheimer’s?

As expected, with greater specificity. The ICD-10 Alzheimer’s codes indicate early or late onset of the disease whereas the ICD-9-CM codes don’t.

Early onset is Alzheimer’s that appears before age 65, and in ICD-10, that code is G30.0. Late onset is age 65 or later, and the code is G30.1.

Early onset can develop as early as age 30, but that’s rare. Usually it appears after age 50, and even then it is not common. In fact, only about 4% of Alzheimer’s patients have that form of the disease.

Therese M. Jorwic, MPH, RHIA, CCS, CCS-P, is assistant professor if health information management at the University of Illinois at Chicago and senior consultant for MC Strategies in Atlanta.

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