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MAJOR NEUROCOGNITIVE DISORDER
(MND): REVERSIBLE FORM
Provider’s guide to diagnose and code Reversible MND
Mild cognitive impairment
Important change
DSM-5 (2013) manual has
renamed the term of dementia to
MND; which expands the
diagnostic criteria to include:
›› Memory impairment
›› Social cognitive dysfunction
›› Complex attention
derangement
Mild cognitive impairment (MCI) is classified as
between normal cognition and MND and is often an
early form of MND. Patients may exhibit:
›› Intact activities of daily living
›› Preserved cognitive function
›› Objective memory dysfunction may be noted
by family or friends such as:
• Inability to remember age, education
or historical background
MND goes beyond dementia
to include dysfunction in the
following forms:
Patients who express signs of aphasia, apraxia,
agnosia, and executive function disturbances are no
longer classified as MCI, but diagnosed as MND
›› Aphasia – Inability to
Reversible MNDs
›› Apraxia – Inability to execute
Reversible MNDs typically resolve once the insulting
disease or noxious substance is removed. Examples
of reversible causes include:
comprehend and express
language
purposeful movements
›› Agnosia – Inability to recognize
or process sensory information
›› Executive function – Inability to
connect past experience with
present action
›› Hypoxia
›› Depression
›› Normal pressure hydrocephalus
• Symptoms include urinary incontinence
and gait defects
›› Medication/toxin
• Alcohol
• Prescriptive or illicit drugs
• Newly added medications, such as
benzodiazepines, opiates, tri-cyclic
antidepressants, anti-convulsants,
fluroquinolone antibiotics, H-2 receptor
antagonists, and corticosteroids
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Reversible MNDs (continued)
›› Acute related illness
• Infection
• Anemia
›› Metabolic derangement
• Dehydration
• Organ failure
• Acidosis
• Thyroid disease
• Hyper/hypo-natremia
• Liver (ammonia)
• Renal (uremia)
ICD-10-CM codes to support a more precise diagnosis
2015 ICD-10-CM
Documentation
In addition to the objective examination it is
important to document behavioral disturbances
such as:
›› Sleep disturbance
›› Agitation
›› Delusion
›› Aggression
›› Hallucination
›› Wandering
It is important to:
›› Include findings that support a diagnosis
of MND
ICD-10ICD-10-CM Description
CM Code
›› Ensure that a treatment plan and follow-up
are included
F10.27
Alcohol dependence with alcohol-induced persisting dementia
F13.27
Sedative, hypnotic or anxiolytic dependence with sedative,
hypnotic or anxiolytic-induced persisting dementia
›› Confirm a face to face encounter is signed and
F13.97
Sedative, hypnotic or anxiolytic use, unspecified with sedative,
hypnotic or anxiolytic-induced persisting dementia
›› Include specific ICD-10 code
F18.17
Inhalant abuse with inhalant-induced dementia
F18.27
Inhalant dependence with inhalant-induced dementia
F18.97
Inhalant use, unspecified with inhalant-induced persisting dementia
F19.17
Other psychoactive substance abuse with psychoactive
substance-induced persisting dementia
F19.27
Other psychoactive substance dependence with psychoactive
substance-induced persisting dementia
F19.97
Other psychoactive substance use, unspecified with
psychoactive substance-induced persisting dementia
Evaluation
dated by a credentialed provider
with written description
Examination
It is important to interview the patient along with an An objective examination needs to
informant. Clinician should ask about deficits with:
include the results of neurocognitive
testing such as:
›› Judgment
›› Memory problems
›› Language
›› Learning elementary
tasks
›› Reduced activity
››
interest
Handling finances
• Appointments
• Days of week
• Specific or
current year
›› Mini-Mental State Exam: http://ncemi.org/
shared/etools_c/etools_c.pl
›› Mini-Cog: http://www.alz.org/documents_
custom/minicog.pdf
›› PHQ-9: http://www.phqscreeners.com/pdfs/02_
PHQ-9/English.pdf
References
CDC. (October, 2013). Dementia/Alzheimer’s disease http://www.cdc.gov/mentalhealth/basics/mental-illness/dementia.htm
McDade, E. M. and Petersen, R. C. Mild cognitive impairment: Epidemiology, pathology, and clinical assessment. In: UpToDate, DeKosky, S. T. (Ed), UpToDate, Waltham, MA. Accessed
on 11/20/2014, http://www.uptodate.com/contents/mild-cognitive-impairment-epidemiology-pathology-and-clinical-assessment?source=search_
resultandsearch=mild+cognitive+impairmentandselectedTitle=1~94
Randolph, C. Frontotemporal dementia: clinical features and diagnosis. In UpToDate, DeKosky, S. T. (Ed), UpToDate, Waltham, MA. Accessed on 11/20/2014, http://www.uptodate.
com/contents/frontotemporal-dementia-clinical-features-and-diagnosis?source=search_
resultandsearch=Frontotemporal+dementia%3A+Clinical+features+and+diagnosisandselectedTitle=1~150
Shadlen, M. and Larson, E. Evaluation of cognitive impairment and dementia. In UpToDate, DeKosky, S. T. (Ed), UpToDate, Waltham, MA. Accessed on 11/20/2014, http://www.
uptodate.com/contents/evaluation-of-cognitive-impairment-and-dementia?source=search_resultandsearch=dementiaandselectedTitle=1~150