D. E86.0, E46
Dehydration and malnutrition are often tied to dementia in older people. A person who has dementia may not eat or drink enough, and that may be due to forgetting to eat, loss of appetite, or the inability to feed oneself.
There are two diagnosis codes needed for this scenario: a code for the dehydration and a code for the malnutrition.
Locate and Verify
Look in the Alphabetic Index under Dehydration E86.0. In the Tabular, we can verify the correct code as:
Locate and Verify
Look up Malnutrition E46. In the Tabular, E46 can be verified as:
E46, Unspecified protein-calorie malnutrition
E46 is also applicable to:
- Malnutrition NOS
- Protein-calorie imbalance NOS
The documentation does not indicate the particular type of malnutrition, so we need to assign the code for unspecified.
The ICD-10-CM Official Guidelines for Coding and Reporting (FY 2022) state, “Sign/symptom and “unspecified” codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter.”
The coding guidelines further state, “If the diagnosis documented at the time of discharge is qulified as “probable, “suspected,” “likely,” “questionable,” “possible,” or “still need to be ruled out,” “compatible with,” “consistent with,” or other similar terms indicating uncertainty, code the condition as if it existed or was established. The basis for these guideliens are the diagnostic workup, arranagement for further workup or observiation, and initial therapeutic approach that correspond most closely with the established diagnosis.”
“Note: This guideline is applicable only to inpatient admissions to short-term, acue, long-term care, and psychiatric hospitals.”
Therefore, based on the guidelines, the suspected diagnosis of dementia should not be coded for this scenario.
Confirmed dementia or “suspected” dementia? It makes a difference.
A. E86.0, E44.1, F03.90. E44.1 refers to Mild protein-calorie malnutrition. F03.90 refers to Unspecified dementia without behavioral disturbance. Although this code is correct when the diagnosis is definitively confirmed, it is a “suspected” diagnosis and cannot be reported in the outpatient setting.
B. E86.0, E43, F02.80. E43 refers to Unspecified severe protein-calorie malnutrition. F02.80 refers to Dementia in other diseases classified elsewhere without behavioral disturbance. This was not documented, nor was it confirmed.
C. E86.0, E43. E43 refers to Unspecified severe protein-calorie malnutrition.
“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” – Aristotle
** This article has been updated to reflect the ICD-10-CM Coding Guidelines for FY 2022. **