Understanding Delirium (Acute Confusional State, Acute Brain Syndrome): Find information on diagnosis, clinical features, documentation guidelines, and ICD-10 coding for delirium. This resource supports healthcare professionals in accurately identifying and managing delirium in patients. Learn about causes, treatment options, and best practices for documenting this acute brain syndrome in medical records.
Also known as
Delirium
Covers various types of delirium, including unspecified, superimposed on dementia, and other.
Disorientation, unspecified
A symptom often present in delirium, indicating confusion about time, place, or person.
Other mental disorders due to brain damage and dysfunction and to physical disease
Includes delirium due to specific conditions not classified elsewhere.
Postoperative delirium
Delirium specifically occurring after a surgical procedure.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the delirium due to a medical condition or substance?
Yes
Due to medical condition?
No
Code as F05.9 Delirium, unspecified. If etiology can be determined, code underlying condition.
When to use each related code
| Description |
|---|
| Sudden confusion and altered mental state. |
| Progressive cognitive decline affecting memory and function. |
| Mild cognitive impairment, noticeable decline, but preserved independence. |
Coding delirium without specific cause (e.g., substance-induced, medication-induced) leads to lower reimbursement and data inaccuracy.
Incorrectly coding pre-existing dementia as delirium can inflate Case Mix Index (CMI) and trigger audits.
Lack of detailed clinical documentation supporting delirium diagnosis can lead to coding queries and claim denials.
Q: How can I differentiate delirium from dementia in an elderly patient presenting with acute confusion?
A: Differentiating delirium from dementia in elderly patients with acute confusion can be challenging, but focusing on key clinical features can help. Delirium typically presents with a sudden onset of fluctuating mental status, inattention, and disorganized thinking. This contrasts with dementia, which usually has a more gradual onset and a relatively stable course, though cognitive fluctuations can occur. A thorough medication review is crucial in delirium cases as it is often precipitated by medications, infections, or metabolic disturbances. Consider implementing the Confusion Assessment Method (CAM) for a rapid bedside assessment of delirium. Explore how the CAM algorithm incorporates features like acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness to assist in diagnosis. Learn more about specific cognitive tests to further differentiate between delirium and dementia.
Q: What are the best evidence-based non-pharmacological interventions for managing delirium in hospitalized patients?
A: Non-pharmacological interventions are a cornerstone of delirium management in hospitalized patients and should be prioritized. These interventions aim to address predisposing and precipitating factors while promoting a calm and orienting environment. Key strategies include frequent reorientation, providing familiar objects and family photos, ensuring adequate hydration and nutrition, promoting early mobilization, managing pain effectively, and minimizing sleep disruptions. Consider implementing a multicomponent non-pharmacological intervention program that addresses these factors comprehensively. Such programs have been shown to reduce delirium incidence and duration. Explore how strategies like the HELP (Hospital Elder Life Program) protocol can be adapted for your hospital setting.
Patient presents with acute onset of altered mental status, consistent with a diagnosis of delirium (acute confusional state, acute brain syndrome). Symptoms include fluctuating attention, disorganized thinking, and perceptual disturbances. Onset was abrupt, developing over the past [number] hours/days. Patient exhibits [specify type of fluctuation, e.g., waxing and waning consciousness, periods of lucidity alternating with confusion]. Cognitive assessment reveals impairments in orientation, memory, and language. Thought processes are disorganized, evidenced by [specify examples, e.g., tangential speech, illogical statements, perseveration]. Perceptual disturbances include [specify if present, e.g., visual hallucinations, misinterpretations, illusions]. The patient's baseline cognitive function is [describe, e.g., intact, mildly impaired due to pre-existing dementia]. Differential diagnosis considered [list, e.g., dementia, depression, psychosis, substance intoxication/withdrawal, metabolic encephalopathy, CNS infection]. Preliminary workup includes [list tests ordered or completed, e.g., complete blood count, comprehensive metabolic panel, urinalysis, blood cultures, toxicology screen, neuroimaging]. Current medications are [list medications]. Underlying medical conditions include [list comorbidities]. The suspected etiology of the delirium is [state suspected cause, e.g., urinary tract infection, medication side effect, dehydration]. Treatment plan includes addressing the underlying cause, supportive care, environmental modifications to promote orientation and safety, and monitoring for symptom resolution. The patient's condition necessitates close monitoring for potential complications, including falls, pressure ulcers, and aspiration pneumonia. Prognosis depends on the identification and successful treatment of the underlying etiology. ICD-10 code F05.9 (Delirium, unspecified) is assigned. This documentation supports medical necessity for [mention services or interventions, e.g., hospital admission, continued inpatient stay, medication management, consultation with specialist].