Ask the Expert

This month’s selection:

How would you code neurocognitive disorder?

Name Withheld by Request

Response:

Neurogenic disorder, unspecified codes to R41.9

The answer to this depends on the specificity of the documentation; If the disorder is Major or Minor, then there would need to be additional information searched in the chart to lead to the specified code. If neurocognitive disorder is not specified, the assigned code would be R419.

— Trudy Alward, CCS, is senior auditor/coder at the Coding Services Group.

Follow-up Question:

Our providers are using neurocognitive disorder with behavioral disturbances at times. From what I have read, would this not be the same as dementia with behavioral disturbances? If the patient has Alzheimer’s dementia would this not be primary as this is the reason for the neurocognitive disorder? I understand the use of the R419 but it’s nonspecific and I need to be more specific for our unit.

Example of Discharge Diagnoses:
Neurocognitive disorder with behavioral disturbances
Major depressive disorder
Alzheimer’s dementia
Confusion

Name Withheld by Request

Response:

Since the physician documented the cause of the neurogenic disorder as Alzheimer’s dementia in the record, Alzheimer’s dementia would be assigned as the diagnosis and not the unspecified code R419.

Neurogenic cognitive disorder
Neurogenic Disorders. Acquired neurogenic communication disorders include aphasia, dysarthria, apraxia, and cognitive-communication impairments. These typically result from brain injuries due to stroke, trauma, brain tumors, or progressive neurological diseases (eg, Parkinson disease, Alzheimer’s dementia, atrophic lateral sclerosis, primary progressive aphasia).

— Trudy Alward, CCS