ICD-10-CM Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders underwent a significant expansion for FY2023 regarding dementia severity and associated behavioral disorders. This expansion includes the addition of 69 codes and a new guideline for medical coders to follow.
Dementia Overview
The Merck Manual defines dementia as the chronic, global, usually irreversible deterioration of cognition. Dementia is generally due to an underlying disorder such as cerebrovascular disease or Alzheimer’s disease; however, a specific underlying cause is not always determined.
The progression of dementia moves through three stages of cognitive impairment: mild, moderate, and severe.
Mild (early) dementia symptoms include impaired recent memory, difficulty learning and retaining new information, mood swings and personality changes. Patients may have difficulty with activities of daily living such as balancing their checkbooks or remembering where they put things and will require occasional daily assistance.
Moderate (intermediate) dementia symptoms include the inability to learn and recall new information, reduction of memory of remote events, progressing personality changes and behavioral disorders such as wandering and aggression. Patients are no longer independent and require frequent assistance with daily living activities.
Severe (late) dementia symptoms include the patient’s inability to walk, feed themselves, or do any other activities of daily living. Memory is completely lost, and patients may lose in the ability to swallow or become incontinent.
Dementia: ICD-10-CM Code Updates
New subcategories have been created with new codes under the following categories:
- Vascular dementia (F01.511-F01.C4)
- Dementia in other diseases classified elsewhere (F02.811-F02.C4)
- Unspecified dementia (F03.911-F03.C4)
69 new codes have been created under these categories to capture the stages of severity and to identify the behavioral and psychological symptoms of dementia (BPSD).
Below are just a handful of codes for vascular dementia:
- A11 Vascular dementia, mild, with agitation
- B4 Vascular dementia, moderate, with anxiety
- C11 Vascular dementia, severe, with agitation
- 518 Vascular dementia, unspecified severity, with other behavioral disturbance
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Dementia: Official Medical Coding Guideline
A new guideline (I.C.5.d.) has been added regarding the basis of the etiology and severity of dementia. The guideline states that selection of the appropriate severity level requires the provider’s clinical judgment and codes should be assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification. If the documentation does not provide information about the severity of the dementia, the appropriate code for unspecified severity should be assigned.
The guideline also states that if a patient is admitted with dementia at one severity level and it progresses to a higher severity level, one code for the highest severity level reported during the stay should be assigned.
I.C.5.d. Dementia
“The ICD-10-CM classifies dementia (categories F01, F02, and F03) on the basis of the etiology and severity (unspecified, mild, moderate or severe). Selection of the appropriate severity level requires the provider’s clinical judgement and codes should be assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification. If the documentation does not provide information about the severity of the dementia, assign the appropriate code for unspecified severity.
If a patient is admitted to an inpatient acute care hospital or other inpatient facility setting with dementia at one severity level and it progresses to a higher severity level, assign one code for the highest severity level reported during the stay.”
Additional Information
The complete ICD-10-CM Official Guidelines for Coding and Reporting FY 2023 can be found on the CMS website by visiting the following link:
https://www.cms.gov/files/document/fy-2023-icd-10-cm-coding-guidelines.pdf
Additional information regarding dementia can be found below:
- “Dementia” Merck Manual, Professional Version https://www.merckmanuals.com/professional/neurologic-disorders/delirium-and-dementia/dementia
- AHA Coding Clinic, Fourth Quarter 2022 Pages: 14-15 “Dementia: stage of severity, behavioral and physical symptoms”
