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October 27, 2008

Coding for Cognitive Disorders
For The Record
Vol. 20 No. 22 P. 28

Cognition is the process of awareness or thought and includes memory, language, attention, perception, and reasoning. A patient with a cognitive disorder, a brain disorder that typically occurs after middle age, has difficulty with one or more types of mental tasks.

Cognitive symptoms include confused thinking, feeling sad or down, excessive fears or worries, withdrawal from friends and activities, problems sleeping, delusions or hallucinations, inability to cope with daily problems or stress, alcohol or substance abuse problems, significant changes in eating habits, sex drive changes, and excessive anger, hostility, or violence.

Common cognitive disorders include the following diagnoses:
• autism (299.0);
• Down syndrome (758.0);
• traumatic brain injury (959.01);
• dementia (294.8);
• attention-deficit disorder (314.0);
• dyslexia (784.61);
• dyscalculia (315.1); and
• learning disabilities.

The progressive deterioration of cognitive function is referred to as dementia. With dementia, brain function impairment is so severe that it affects a person’s ability to function at his or her usual level. The following are the major stages of dementia:
• mild cognitive impairment (memory problems);
• mild dementia (impaired memory and thinking skills);
• moderate dementia (severe memory impairment and difficulty in communication);
• severe dementia (severe problems with communication and frequent incontinence); and
• profound dementia (bedridden).

At some point during the stages of dementia, it becomes apparent that the patient can no longer live alone. The following are some common causes of irreversible dementia:
• Alzheimer’s disease (331.0 + 294.1x) — the most common cause of dementia.
• Multi-infarct dementia (290.4x + 437.0) — caused by strokes that stop the blood flow to parts of the brain. The fifth-digit subclassification with code 290.4 identifies the presence of delirium, delusional features, or depressive features. This type of dementia may also be documented as vascular dementia.
• Parkinson’s disease (331.82 [BR checking] + 294.1x) — a movement disorder with bradykinesia, rigidity, and tremors.
• Dementia with Lewy bodies (331.82 + 294.1x) — causes protein deposits (Lewy bodies) in neurons. A unique symptom for this condition is visual hallucinations.
• Frontotemporal dementia (331.19 + 294.1x) — main symptom is changes in personality or behavior. The patient may display inappropriate social behavior.
• Pick’s disease (331.11 + 294.1x).
• Huntington’s disease (333.4 + 294.1x) — rare, inherited disease.

Code 294.1 requires a fifth-digit subclassification to identify whether the dementia is occurring with or without behavioral disturbances. Behavioral disturbances include aggressive behavior, combative behavior, violent behavior, and wandering off.

Drug-Induced Mental Disorders
Drug dependence occurs when there is a physical addiction to a drug, and the person continues to use the drug despite the negative social, psychological, and physical problems it causes. Patients with drug dependence may develop physical or psychological symptoms related to the drug use. Some of the common mental disorders related to drug use include the following:
• drug withdrawal (292.0);
• drug-induced paranoia (292.11);
• drug-induced hallucinations (292.12);
• drug-induced delirium (292.81);
• drug-induced dementia (292.82);
• drug-induced amnestic disorder (292.83);
• drug-induced mood disorder (eg, depression; 292.84);
• drug-induced sleep disorder (eg, insomnia; 292.85);
• drug-induced anxiety disorder (292.89); and
• drug-induced sexual dysfunction (292.89).

Coding and sequencing for cognitive disorders are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.