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Neurologists' use of ICD-9CM codes for dementia
M Pippenger1, R G Holloway, B G Vickrey
1Department of Neurology, University of California, Los Angeles, 90095-1769, USA. mpippeng@ucla.edu
Insights
Neurologists infrequently used the specific ICD-9CM code for Alzheimer's disease (AD) in dementia patients. This inconsistent coding impacts research accuracy and potentially reduces healthcare reimbursement for neurological conditions.
Area of Science:
- Neurology
- Medical Informatics
Background:
- Accurate coding of diagnoses is crucial for medical research and reimbursement.
- Dementia diagnosis, particularly Alzheimer's disease (AD), requires precise medical coding.
Purpose of the Study:
- To examine the utilization of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes by neurologists for dementia patients.
- To assess the accuracy and consistency of coding for Alzheimer's disease (AD).
Main Methods:
- A review of 181 new dementia patient cases evaluated by 48 neurologists in the Rochester, NY area over one year.
- Analysis of the specific ICD-9-CM codes used, particularly code 331.0 for AD.
Main Results:
- Only 36.5% of patients diagnosed with probable AD were assigned the specific ICD-9-CM code 331.0.
- Alternative, though not inaccurate, codes were frequently used, potentially leading to lower reimbursement.
- Significant variation in coding practices among neurologists was observed.
Conclusions:
- Neurologists' coding practices for dementia, including Alzheimer's disease, are inconsistent.
- Variations in ICD-9-CM code usage can compromise the validity of dementia research relying on claims data.
- Standardized coding protocols may be necessary to improve data accuracy in neurological research.
Abstract:
Neurologists' use of ICD-9CM codes in a sample of 181 consecutive, new patients evaluated for dementia by 48 of all 49 neurologists from the Rochester, NY, area over a 1-year period was examined. The specific code for AD, 331.0, was used for only 36.5% of patients judged by the neurologist to have AD as the most likely diagnosis. Other codes used were not inaccurate but would result in lower reimbursement. Variation in coding could affect validity of dementia research using claims data.