Alzheimer’s disease is a progressive brain disorder that gradually destroys memory and thinking capabilities. This condition is irreversible and the most common cause of dementia (loss of thinking, remembering, reasoning and other cognitive functioning that affect a person’s daily life and activities) in older adults. If genetic mutation is often the cause for early-onset Alzheimer’s, the complex series of brain changes that occur over decades is the cause for late-onset Alzheimer’s. A combination of genetic, environmental and lifestyle factors are the most possible causes. Though the first symptoms of Alzheimer’s may vary according to the person, decline in non-memory aspects of cognition including word-finding, vision/spatial issues and weakened reasoning or judgment may indicate very early stages of this disease. People with mild cognitive impairment (MCI) may be at greater risk for Alzheimer’s. Detecting early changes in the brains of individuals with higher risk for Alzheimer’s is very important for providing appropriate care. Reporting the diagnosis with appropriate codes is equally important to ensure correct reimbursement. Healthcare providers are paid for services based on the medical codes assigned to a patient’s diagnoses and procedures. Therefore, accurate medical coding is essential to ensure timely claim reimbursement.
Why Early Diagnosis of Alzheimer’s Is Crucial
- There are several conditions in addition to Alzheimer’s that share some of the same characteristics, some of them are treatable and some are even reversible. If such conditions are diagnosed and treated at an early stage, it can bring about a better outcome.
- Early diagnosis helps the patients to become eligible for more clinical trials and benefit from the medications tested.
- The medications approved by FDA are helpful during the early stages of this disease process in general though some people report a significant improvement while some show negligible change.
- There is some proof that other interventions apart from medications can reduce the rate of progression of this disease such a physical exercise, mental exercise, and meaningful activities. However, they are beneficial only during the earlier stages of the disease.
- If this condition is detected earlier, patients and healthcare providers can get more time to discuss about the care and treatment. This will also provide time for patients to record their memories in several ways.
- An early diagnosis helps the physician to understand the patient better and provide appropriate guidance and care.
Diagnostic Tests and Treatment
In order to choose a diagnostic test for Alzheimer’s disease, physicians need to consider the reports of physical examination and patient’s history. The most common tests available are laboratory tests (blood test, urinalysis), lumbar puncture/spinal tap, computed tomography (CT) scan, magnetic resonance imaging (MRI), electroencephalography (EEG), electrocardiogram (ECG or EKG), neuropsychological testing, positron emission tomography (PET) scan and single photon emission computed tomography (SPECT) scan. Depending upon the coverage, you can use CPT or HCPCS codes to report the diagnostic tests performed. For example, here are the CPT codes used to report neuropsychological testing.
- 96116: Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report
- 96118: Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report
- 96119: Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face
- 96120: Neuropsychological testing (e.g., Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report
Genetic testing is conducted for familial Alzheimer’s disease. There are no specific CPT codes for this test. The HCPCS codes used to report this test are:
- S3852: DNA analysis for APOE epsilon 4 allele for susceptibility to Alzheimer’s disease
- S3855: Genetic testing for detection of mutations in the presenilin-1 gene
You may need to add diagnosis codes and sometimes modifiers when reporting this condition.
The U.S. Food and Drug Administration or FDA approved several medications to treat the symptoms of Alzheimer’s disease. Rivastigmine (Exelon®) and galantamine (Razadyne®) are used to treat mild to moderate Alzheimer’s while donepezil (Aricept®) can be used to treat mild, moderate and severe Alzheimer’s.
Memantine (Namenda®) can be used to treat moderate to severe Alzheimer’s. Researchers are going on to find effective treatment for behavioral symptoms and address underlying diseases process.
Reporting Diagnosis of Alzheimer’s
- 290.0: Senile dementia, uncomplicated
- 290.10: Presenile dementia, uncomplicated (Code first the associated neurological condition)
- 290.11: Presenile dementia with delirium (Code first the associated neurological condition)
- 290.12: Presenile dementia with delusional features (Code first the associated neurological condition)
- 290.13: Presenile dementia with depressive features (Code first the associated neurological condition)
- 290.20: Senile dementia with delusional features (Code first the associated neurological condition)
- 290.21: Senile dementia with depressive features (Code first the associated neurological condition)
- 290.3: Senile dementia with delirium (Code first the associated neurological condition)
- 294.10: Dementia in conditions classified elsewhere without behavioral disturbance
- 294.11: Dementia in conditions classified elsewhere with behavioral disturbance
- 294.20: Dementia, unspecified, without behavioral disturbance
- 294.21: Dementia, unspecified, with behavioral disturbance
- 331.0: Alzheimer’s disease
- V69.8: Other problems related to lifestyle
The most appropriate code used for diagnosis and management of Alzheimer’s disease is 331. Medicare reimburses this code at a higher rate. Alzheimer’s can also be billed with 290 (pre-senile dementia). However, 290 gets reimbursed at a lower rate under Medicare like other private health insurance plans.
- F03.90: Unspecified dementia without behavioral disturbance
- F05: Delirium due to known physiological condition
You can use F03.90 for: senile dementia uncomplicated, pre-senile dementia uncomplicated, pre-senile dementia with delirium, pre-senile dementia with depressive features and senile dementia with depressive features. Both F03.90 and F05 should be used if the patient has pre-senile dementia with delusional features, senile dementia with delusional features and senile dementia with delirium.
- F02.80: Dementia in other diseases classified elsewhere without behavioral disturbance (Code first the underlying physiological condition)
- F02.81: Dementia in other diseases classified elsewhere with behavioral disturbance (Code first the underlying physiological disease, such as Alzheimer (G30.))
- F03.91: Unspecified dementia with behavioral disturbance
- G30.0: Alzheimer’s disease with early onset
- G30.1: Alzheimer’s disease with late onset
- G30.8: Other Alzheimer’s disease
- G30.9: Alzheimer’s disease, unspecified
- Z72.89: Other problems related to lifestyle
When it comes to G30 codes, use additional codes to identify delirium (F05), dementia with behavioral disturbance (F02.81) and dementia without behavioral disturbance (F02.80), if applicable.