Did the ICD-10 codes for Dementia recently change?
Yes, the FY 2023 ICD-10 updates (effective 10/01/22) include updated codes that provide greater specificity based on severity and behavioral symptoms present. The ICD-10-CM now classifies dementia on the basis of the etiology (F01-Vascular Dementia; F02- Dementia in other diseases, such as Alzheimer’s; F03-unspecified etiology) and severity (mild- 4th character A, moderate-4th character B, or severe-4th character C). The 5th character is still used to identify if the dementia is with behavioral symptoms (5th character 1) or without behavioral symptoms (5th character 0), in addition to new options for coding dementia with psychotic disturbance, such as hallucinations, paranoia, suspiciousness, or delusional state (5th character 2), with mood disturbance, such as depression, apathy, or anhedonia (5th character 3); or with anxiety (5th character 4). For dementia with behavioral symptoms, a 6th character is now required to provide further specificity on the specific type of behavioral disturbance present (1=with agitation; 8= other behavioral disturbance, such as sleep disturbance, social disinhibition, or sexual disinhibition). For example, if the physician documents a diagnosis of mild dementia with paranoia, you would code it as F03.A2 Unspecified dementia, mild, with psychotic disturbance. If the physician documents a diagnosis of Alzheimer’s dementia with paranoia, you would first code the Alzheimer’s G30.9 and F02.82 Dementia in other diseases classified elsewhere, unspecified severity, with psychotic disturbance.
According to the ICD-10-CM Official Guidelines for Coding and Reporting, 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, assign the appropriate code for unspecified severity. If a patient is admitted 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.