ICD-10 Coding for Sundowning(F05, G30.1)
Complete ICD-10-CM coding and documentation guide for Sundowning. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sundowning
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F05 | Delirium due to known physiological condition | Use when delirium is directly tied to a known physiological condition such as dementia. |
|
| G30.1 | Alzheimer's disease with late onset | Use when Alzheimer's disease is the underlying condition for sundowning. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for sundowning
Essential facts and insights about Sundowning
Primary ICD-10-CM Codes for sundowning
Decision Criteria
clinical Criteria
- Presence of late-day confusion linked to a physiological condition
coding Criteria
- Sequence underlying condition before F05
Applicable To
- Sundowning
Excludes
- Delirium NOS (R41.0)
Clinical Validation Requirements
- Worsening confusion after 3PM
- Circadian disruption
- Link to dementia or other physiological condition
Code-Specific Risks
- Incorrect sequencing with underlying condition
- Confusion with R41.0
Coding Notes
- Ensure the underlying condition is coded first to comply with sequencing rules.
G30.1 - Alzheimer's disease with late onset
Use when Alzheimer's disease is the underlying condition for sundowning.
Clinical Validation Requirements
- Diagnosis of Alzheimer's disease
- Late onset symptoms
Coding Notes
Ensure Alzheimer's is documented as the underlying condition.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Wandering in diseases classified elsewhere
Z91.83Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Delirium NOS
R41.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sundowning to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F05.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific language to describe symptoms, Link symptoms to underlying conditions
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use F05 when sundowning is linked to a known physiological condition.
Impact
Failure to sequence the underlying condition before F05.
Mitigation Strategy
Ensure training on proper sequencing rules.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Sundowning, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sundowning
Use these documentation templates to ensure complete and accurate documentation for Sundowning. These templates include all required elements for proper coding and billing.
Sundowning in Alzheimer's patient
Specialty: GeriatricsRequired Elements
- Symptom timing
- Underlying condition
- Differential diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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