About the 2023 Dementia ICD-10 Code Updates

Dementia is a growing health concern due to the aging baby boomer generation. In response to this increasing healthcare burden, CMS is seeking more detailed information on dementia severity and associated behavioral disorders which are likely to support improvements in clinical care and to identify levels of expenditure.

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The FY 2023 ICD-10 updates are now in effect, which means therapists and interdisciplinary teams should take note of the added specificity. The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS), have provided the necessary guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).

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The 2023 ICD-10 code set now includes 89 new codes, out of which 69 codes are related to dementia, allowing for the classification and reporting of conditions like vascular dementia (F01.5-F01.C4), dementia in other diseases (F02.8-F02.C4), and unspecified dementia (F03.9-F03.C4). The new guidelines for reporting dementia emphasize that providers must clearly document the severity of the patient’s condition. If the documentation is incomplete, the coder should default to unspecified dementia without a severity code. The updated guidelines also offer the instruction that, if a patient with dementia is admitted to an inpatient facility and gets worse during their stay, the coder should assign the highest severity level reported during the stay.

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The ICD-10 Coordination and Maintenance Committee has also provided clarifications to help determine the dementia stage:

• Mild dementia: “Clearly evident functional impact on daily life, affecting mainly instrumental activities. No longer fully independent/requires occasional assistance with daily life activities.”
• Moderate dementia: “Extensive functional impact on daily life with impairment in basic activities. No longer independent and requires frequent assistance with daily life activities.”
• Severe dementia: “Clinical interview may not be possible. Complete dependency due to severe functional impact on daily life with impairment in basic activities, including basic self-care.”

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As mentioned above, 89 new codes were added to Chapter 5 (Mental, Behavioral and Neurodevelopmental disorders [F01-F99]) of ICD-10-CM, including 69 new codes for dementia with and without psychological symptoms. The updated ICD-10-CM classifies dementia (categories F01, F02, and F03) on the basis of the etiology and severity (unspecified, mild, moderate, or severe).

• F01.5-, “Vascular dementia,” is being relabeled as “Vascular dementia, unspecified severity.” This will distinguish it from a long series of codes starting with F01.A- that describe specific levels of severity:
• F01.A- Vascular dementia, mild
• F01.B- Vascular dementia, moderate
• F01.C- Vascular dementia, severe.

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In the F02.- and F03.- code families, similar revisions are being made:

• F02.8- will become “Dementia in other diseases classified elsewhere, unspecified severity” with the addition of F02.A- through F02.C- that describe specific levels of severity
• F03.9- will become “Unspecified dementia, unspecified severity” with the addition of F03.A- through F03.C- that describe specific levels of severity.

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These new dementia codes were discussed during the ICD-10-CM Coordination and Maintenance Committee 2021 meetings in both March and September. The proposal stated: “Although codes exist for dementia without and with behavioral disturbances, there is a need for additional detail on other key associated disorders, particularly psychotic disorders, mood disorders, and anxiety.”

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