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Non-memory Alzheimer’s SymptomsAlzheimer’s is a progressive brain disease that causes problems with memory, thinking and behavior. The 6th leading cause of death in the United States, Alzheimer’s is a group of brain disorders that results in the loss of intellectual and social skills that potentially interferes with day-to-day life. It’s a common form of dementia wherein the brain cells themselves degenerate and die causing a steady decline in memory and mental function. Reports suggest that about 5.3 million people in the US are living with this disease. According to the Centers for Disease Control and Prevention (CDC), 1-in-3 seniors die with this disease or another kind of dementia. This condition occurs from a combination of genetic, lifestyle and environmental factors that affect the brain over time.

There are different signs and symptoms associated with this condition and in most cases these symptoms first appear after the age of 65 years. Generally, increasing forgetfulness, mild confusion or difficulty to remember new pieces of information may be the initial symptoms of this disease. The rate at which these symptoms worsen varies from one person to another.

Neurologists treating Alzheimer’s patients have to report the correct diagnostic and procedural codes on the medical claims.

In ICD-10, the following codes are used

  • G30 – Alzheimer’s disease
  • 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

Under category G30, coders need to assign the following additional codes to signify

  • F05 – Delirium, if applicable
  • F02.81 – Dementia with behavioral disturbance
  • F02.80 – Dementia without behavioral disturbance

Generally, memory loss is considered to be the first typical symptom of Alzheimer’s disease. But according to a new study, many middle-aged or younger people are more likely to experience different cognitive problems such as trouble with judgment, language or visual problem solving and spatial awareness as the initial symptom of this disease. The study, one of the largest of its kind to date, aimed to analyze how a person’s age may directly affect the initial symptoms (evaluating both cognitive symptoms such as thinking skills and behavioral symptoms).

The study was led by researchers at the University College of London (UCL) and part-funded by Alzheimer’s Research UK (the UK’s leading dementia research charity) and the findings were published in the Journal Alzheimer’s & Dementia.

As part of the study, researchers analyzed data from 7,815 people (in the US National Alzheimer Coordinating Center (NACC) database) which comprised records of people attending Alzheimer’s disease centers across the US. The average age of the group was 75 years with the oldest aged 110 years and the youngest aged 36 years. Each participant had a diagnosis of this disease and a record was maintained detailing the immediate signs and symptoms they suffered during the early stages of this disease.

It was found that younger people suffered non-memory problems initially. This included difficulty with judgment or problem solving, problems with language, or loss of visual or spatial awareness. The other key findings of the study include

  • Among people below the age group of 60 years, a quarter reported that their first symptom was not memory loss.
  • Patients who reported cognitive difficulties as their first symptoms, the proportion citing reasons other than memory reduced with increasing age. One in five patients aged 60 years cited difficulties unrelated to memory, however this number dropped to one in ten for people in their 70s and one in fifteen for those in their 80s and older.
  • There were significant differences between people’s behavioral symptoms and the most common behavioral symptoms were apathy or withdrawal.
  • When compared to older age groups, younger people suffered depression or other symptoms such as anxiety. On the other hand, older people were more likely to have had psychosis or no behavioral symptom at all (when compared to younger people).

The findings of the study highlight the various ways in which this disease can significantly affect the cognitive brain function. Brain imaging studies have suggested that it can significantly affect different parts of the brain in younger people and this is evident from some of the other symptoms (other than memory) explained in the study.

Further, the study signifies the need for greater understanding and awareness of symptoms (other than memory loss), which is crucial to diagnose this condition early and correctly (particularly for those whose symptoms are not typical of the disease).

Generally, there is no specific test today that confirms Alzheimer’s disease. However, several cognitive tests and physical and neurologic examination help to confirm the presence of this brain syndrome. Neurologists may ask for several brain imaging tests such as magnetic resonance imaging (MRI), computerized tomography (CT), and positron emission tomography (PET) to confirm whether the patient has this condition.

Physicians need to use tests that do not solely focus on memory, but also consider some of the different ways in which Alzheimer’s can manifest. They need to obtain a detailed medical and family history (including psychiatric history and cognitive and behavioral changes). Physicians can make judgments based on the information provided by patients and the results of various tests they conduct to clarify the diagnosis. This in turn can generate public awareness of this condition and help improve support services.

The HOPE Act

According to the Alzheimer’s Association, about half of the individuals who meet the specific diagnostic criteria for dementia have never received a diagnosis. However, the “Health Outcomes, Planning, and Education” (HOPE) Act is expected to bring significant changes to this growing scenario. The HOPE Act would

  • Provide Medicare coverage for a package of services including clinical diagnosis of Alzheimer’s disease, comprehensive care planning services for newly diagnosed individuals and their caregivers and information on treatment and support services.
  • Require clinical documentation of the diagnosis and care planning services in a beneficiary’s medical record to assist in the coordination of care and management of other conditions.

An early and documented diagnosis when combined with access to care planning services helps to improve outcomes for individuals with Alzheimer’s as well as their caregivers.