your input..Alzheimer w/ depressive disorder

[Anne]

Today I was a bit confused while searching for a code one of my doctors presented for a nursing home patient. Mind you all I had was the Date of Service, patient's name and the diagnoses (typical for the nursing homes). This one particular code was "Alzheimer's with depressive disorder." I spent a fair amount of time researching this prior to calling our "billing department" (the company who was doing the billing for 13 yrs prior to my starting in house) for assistance. I will call them for a second opinion, just in case... the person I spoke to who "has been certified for over 14 years" couldn't find any codes and told me to "just put Alzheimer's at this point, it doesn't matter". I told her it couldn't be done that way. She said not to waste any more tiime on it. I spent another 5 minutes and believe I found the appropriate code. I would appreciate your input please... I coded 331.0, 300.4 Alzheimer's Dysthymic disorder (depressive reaction) based on the coder's dictionary.
Thanks in advance, and sorry for the long post here.

 

[Ruth Sheets]

Your codes seem reasonable to me.
I'm thinking the person you talked to on the phone was feeling overwhelmed at the time. It's good you persevered and found the specific codes you needed. Bravo!

 

[Alicia Scott]

Dysthymic disorder means chronic depression.
Depressive disorder is coded 311.

Mood Disorders: What Is Dysthymic Disorder?
This mood disorder is a less severe form of depression. Although less extreme, dysthymic disorder causes chronic of long-lasting moodiness. With dysthymic disorder, low, dark moods invade your life nearly every day for two years or more. Dysthymia is contrasted with a full major depressive episode that lasts two years or longer, which is called chronic major depression.

Dysthymic disorder can occur alone or along with other psychiatric or mood disorders. As with depression, dysthymic disorder is more common in women than in men. A family history of mood disorders is not uncommon. This mood disorder tends to appear earlier than major depression, although it can begin anytime from childhood to later in life.

Up to 5% of the general population is affected by dysthymic disorder. But its cause is not well understood. A combination of factors likely conspires to create this mood disorder. These factors may include:

• Genetics
• Abnormalities in the functioning of brain circuits involve in emotional processing
• Chronic stress or medical illness
• Isolation
• Poor coping strategies and problems adjusting to life stresses

These factors can feed off each other. For example, if you always see "the glass as half empty," you may reinforce the symptoms of depression. And a chronic mood disorder can sensitize you to stress, further feeding your risk for depression.

 

[Anne]

Thank you Alicia, typically, I do bill 311 for depression when the doctor indicate that as the diagnosis. However, with this particular diagnosis, it was indicated differently so I went with what my AAPC ICD9-CM book showed (volume 1-pg 87 300.4 Dysthymic disorder DEF: Depression without psychosis; less severe depression related to personal chnage or unexpected circumstances; also referred to as "reactional depression." This was one of those codes where I was "second guessing" myself at the time.

 

[Alicia Scott]

I saw that also Anne. Is there any documentation to show that this is reactionary? As in d/t something going on in his life. Just to back it up. This is a really good one Anne. I think we could do a slide on this for the monthly Q&A.