ICD-10-CM F02.811: Dementia with Agitation
ICD-10-CM code F02.811 is used to classify dementia originating from other diseases and presenting with agitation. The 'unspecified severity' qualifier indicates that while the symptoms are present, their impact has not been fully defined. In documenting this code, consider both cognitive impairments and behavioral disturbances, noting specific instances of agitation. A thorough clinical correlation is necessary, ensuring that the patient's medical records reflect the diagnosis accurately for compliance with CMS guidelines and to substantiate medical necessity.
Overview
F02.811 refers to dementia that occurs as a result of other diseases not specifically classified under dementia categories, such as Parkinson's disease, Huntington's disease, or multiple sclerosis. This code is used when the severity of dementia is unspecified but is accompanied by agitation, which can manifest as restlessness, irritability, or aggressive behavior. Agitation in dementia patients can complicate care and management, often requiring tailored interventions. Cognitive assessments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), are crucial for evaluating the extent of cognitive impairment. Behavioral symptoms associated with this code can significantly impact the quality of life for both patients and caregivers, necessitating comprehensive support strategies. Caregiver education and support are vital, as caregivers often face challenges in managing agitation and other behavioral symptoms, which can lead to caregiver burnout if not addressed adequately.
Coding Complexity
Rating: Medium
Factors:
- Variety of underlying diseases that can cause dementia
- Need for precise documentation of agitation symptoms
- Differentiation from other types of dementia codes
- Potential for overlapping symptoms with other psychiatric conditions
- Variability in severity assessment
Comparison:
Compared to related codes such as F02.80 (Dementia in other diseases classified elsewhere, unspecified severity), F02.811 is more complex due to the requirement to document agitation, which adds a layer of specificity and necessitates careful clinical assessment.
Audit Risk Factors:
- Inadequate documentation of agitation symptoms
- Failure to specify the underlying disease causing dementia
- Lack of cognitive assessment results in the medical record
- Inconsistent use of the code across different encounters
- Misclassification of severity levels
Specialty Focus
- Specialty: Neurology
Documentation Requirements: Detailed neurological assessments, cognitive testing results, and behavioral observations.
Common Clinical Scenarios: Patients presenting with cognitive decline and agitation due to neurodegenerative diseases.
Special Considerations: Ensure comprehensive documentation of both cognitive and behavioral symptoms to support the use of F02.811. - Specialty: Psychiatry
Documentation Requirements: Psychiatric evaluations, treatment plans addressing agitation, and caregiver support strategies.
Common Clinical Scenarios: Management of agitation in dementia patients with underlying psychiatric conditions.
Special Considerations: Document the impact of agitation on the patient's daily functioning and caregiver stress.
Coding Guidelines
According to ICD-10 guidelines, F02.811 should be used when dementia is a consequence of another disease and is accompanied by agitation. Documentation must clearly indicate the presence of agitation and the underlying condition causing dementia.
Related CPT Codes
- Code: 96116
Procedure Name: Neuropsychological testing
Clinical Scenario: Used to assess cognitive function in patients with dementia and agitation.
Documentation Requirements: Results of cognitive assessments and behavioral observations.
Specialty Considerations: Neurologists and psychiatrists should ensure thorough documentation of test results.
Billing Information
Billing for F02.811 requires comprehensive documentation of the patient's cognitive and behavioral symptoms, including the impact on daily functioning and caregiver involvement.
Additional Resources
Related CPT Codes
Helpful links for mental health billing and documentation
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Q: What documentation is required for coding F02.811?
When documenting F02.811, it is essential to include a clear diagnosis of dementia linked to a specified underlying condition. Record any observed behavioral symptoms, such as agitation, along with detailed observational notes that describe these episodes. Ensure the documentation captures the nature, frequency, and settings in which agitation occurs. Specify any contributing physical or environmental factors. Additionally, outline any non-pharmacological interventions attempted to manage these behaviors. Complete medical records must support the presence of dementia symptoms and the necessity for monitoring or intervention, aligning with CMS criteria for reimbursement.
Q: How does F02.811 differ from other dementia codes?
F02.811 is specifically designated for patients presenting with dementia associated with conditions classified elsewhere and exhibiting agitation. Unlike other dementia codes, F02.811 focuses on behavioral symptoms rather than severity or type of dementia itself. This code is crucial for reflecting significant behavioral disturbances that might impact a patient's care plan or environmental needs. By differentiating from other codes, it emphasizes adjunctive concerns beyond primary cognitive issues, which may necessitate distinct therapeutic approaches or interventions.
Q: Why is specificity important in coding F02.811?
Specificity in coding F02.811 ensures that the medical records accurately reflect not only the presence of dementia but the exact nature of associated behavioral issues. Detailed documentation supports the medical necessity of interventions and aligns with audit expectations. Specificity aids in refining patient care, enabling targeted management plans tailored to both cognitive and behavioral symptoms. It impacts billing, reimbursement, and overall care quality, ensuring comprehensive coverage of the patient's health status.
Q: What are the audit considerations for F02.811?
Audits for F02.811 focus on confirming diagnoses are accurately documented and supported within the patient's medical record. Compliance auditors will review the specificity and clarity of the underlying condition causing dementia and accompanying behavioral symptoms. They will assess whether recorded interventions or observations align with CMS guidelines and verify the correlation between documented agitation episodes and medical services rendered. Having comprehensive records detailing the patient's condition, behavioral manifestations, and subsequent management plans minimizes risk during audits and substantiates the coding choice.
Q: What role does behavioral health context play in coding F02.811?
Behavioral health context is integral to coding F02.811 as it highlights the need to address the psychological and environmental factors affecting dementia patients. This code captures the behavioral manifestations of agitation, necessitating that clinicians consider broader mental health issues in their evaluations. Recognizing this context aids in formulating holistic care plans and interventions, potentially involving behavioral health specialists. Thus, comprehensive documentation should include any psychological assessments, behavioral interventions, and multi-disciplinary team input to reflect the extensive care required for such conditions.