Alzheimer’s, Up Close and Personal

An insider’s look at coding Alzheimer’s and its associated symptoms.

EDITOR’S NOTE: The following is an edited transcript of Laurie Johnson’s recent appearance on Talk Ten Tuesdays.

The late President Ronald Reagan designated November as National Alzheimer’s Disease Awareness Month in 1983 in order to help fight the dreaded condition.

As Baby Boomers age, more people will be diagnosed with Alzheimer’s. I have become very knowledgeable about this disease, as my grandmother, two aunts, and my mother have had it. Today, I would like to discuss the coding of Alzheimer’s and its associated symptoms.

The Index lists Alzheimer’s under “disease,” with the sub-term of Alzheimer’s. The default code is the actually a slanted bracket code, which means that two codes are required to code this condition fully. The code outside the slanted bracket is coded first, with the code inside the slanted bracket used as a secondary code. The default codes are G30.9 and F02.80: the first code is for Alzheimer’s disease, while the second provides the detail that no behavioral disturbance is noted. If there is behavioral disturbance, then the second code would be F02.81.  

Another symptom of Alzheimer’s disease is the tendency to wander. This symptom can also be coded as Z91.83.

From the clinical documentation improvement perspective, Alzheimer’s can be further specified as early onset (G30.0) or late onset (G30.1). The early onset is also known as presenile dementia, and it is usually diagnosed before the age of 65. Late onset is known also as senile dementia. There is one more option in the G30 category, which is G30.8 (other Alzheimer’s disease). One condition coded in this subcategory is atypical dementia. It should also be mentioned that senile degeneration is not the same as Alzheimer’s disease, which is evidenced by the exclusion under the code for senile degeneration (G31.1).

There was a question in the Coding Clinic published in the first quarter of 2017 regarding the documentation of dementia with Alzheimer’s. The response was that dementia is inherent in Alzheimer’s, so specific documentation of dementia is not needed for code assignment. If the patient suffers from contractures due to immobility that requires physical therapy, the coder should assign the contracture codes, according to the 2016 second-quarter Coding Clinic.

The G30 category has an instructional note that reads, “use additional code to identify delirium, if applicable; dementia with behavioral disturbance; or dementia without behavioral disturbance.” The behavioral disturbance (F02.8-) is the second code in the slanted bracket combination. The code for dementia with behavioral disturbance is a complication/comorbid condition (CC) and can impact MS-DRGs. All of these conditions are found among the Hierarchical Condition Categories, or HCCs, which impact payment for managed care or Medicare Advantage beneficiaries.

My experience has been that although my mother and her sisters have this disease, the manifestations have been different. My mother is very forgetful and loses track of time. Her oldest sister has exhibited mood changes and began to sleep through the day. Their middle sister quickly slipped away. She had different symptoms as well. The one common characteristic is that they have all withdrawn from life, which was the same experience as my grandmother. My grandmother also had the wandering behavior.

I am sure that my family is just one of many examples of what many families are experiencing with this disease.