Abstract:
:The objectives of this study were to review the diagnostic, International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM), diagnosis related groups (DRGs), and common procedural terminology (CPT) coding and reimbursement issues (including Medicare Part B reimbursement for physicians) encountered in caring for patients with Alzheimer's disease and related dementias (ADRD); to review the implications of these policies for the long-term clinical management of the patient with ADRD; and to provide recommendations for promoting appropriate recognition and reimbursement for clinical services provided to ADRD patients. Relevant English-language articles identified from MEDLINE about ADRD prevalence estimates; disease morbidity and mortality; diagnostic coding practices for ADRD; and Medicare, Medicaid, and managed care organization data on diagnostic coding and reimbursement were reviewed. Alzheimer's disease (AD) is grossly undercoded. Few AD cases are recognized at an early stage. Only 13% of a group of patients receiving the AD therapy donepezil had AD as the primary diagnosis, and AD is rarely included as a primary or secondary DRG diagnosis when the condition precipitating admission to the hospital is caused by AD. In addition, AD is often not mentioned on death certificates, although it may be the proximate cause of death. There is only one ICD-9-CM code for AD-331.0-and no clinical modification codes, despite numerous complications that can be directly attributed to AD. Medicare carriers consider ICD-9 codes for senile dementia (290 series) to be mental health codes and pay them at a lower rate than medical codes. DRG coding is biased against recognition of ADRD as an acute, admitting diagnosis. The CPT code system is an impediment to quality of care for ADRD patients because the complex, time-intensive services ADRD patients require are not adequately, if at all, reimbursed. Also, physicians treating significant numbers of AD patients are at greater risk of audit if they submit a high frequency of complex codes. AD is grossly undercoded in acute hospital and outpatient care settings because of failure to diagnose, limitations of the coding system, and reimbursement issues. Such undercoding leads to a lack of recognition of the effect of AD and its complications on clinical care and impedes the development of better care management. We recommend continuing physician education on the importance of early diagnosis and care management of AD and its documentation through appropriate coding, expansion of the current ICD-9-CM codes for AD, more appropriate use of DRG coding for ADRD, recognition of the need for time-intensive services by ADRD patients that result in a higher frequency of use of complex CPT codes, and reimbursement for CPT codes that cover ADRD care management services.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Fillit H,Geldmacher DS,Welter RT,Maslow K,Fraser Mdoi
10.1046/j.1532-5415.2002.50519.xsubject
Has Abstractpub_date
2002-11-01 00:00:00pages
1871-8issue
11eissn
0002-8614issn
1532-5415pii
jgs50519journal_volume
50pub_type
杂志文章,评审abstract:OBJECTIVE:Recent studies have suggested that vascular dementia in older persons is more common than previously hypothesized. A substantial proportion of dementia in old age may be an early manifestation of cerebrovascular disease (CVD), that eventually becomes clinically evident as an acute cerebrovascular accident. Th...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1996.tb00908.x
更新日期:1996-03-01 00:00:00
abstract::The necessity and safety of an oral calcium (Ca) and vitamin D regimen was evaluated in a population of 66 independently living and 73 institutionalized elderly women over an 11-week winter period. The members of both groups were randomly assigned into trial and control groups. Serum Ca, creatinine, and calcidiol leve...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1532-5415.1990.tb05700.x
更新日期:1990-08-01 00:00:00
abstract:OBJECTIVE:To determine if Staphylococcus aureus and Staphylococcus epidermidis, etiologic bacterial agents to late prosthetic joint infections (LPJI), are more prevalent in the oral flora of older individuals with rheumatoid arthritis (RA) than in an age and gender-matched nonarthritic control population (NA). DESIGN:...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1997.tb03092.x
更新日期:1997-05-01 00:00:00
abstract:BACKGROUND:Guidelines recommend avoidance of several psychoactive medications such as hypnotics in older adults due to their adverse effects. Older patients on hemodialysis may be particularly vulnerable to complications related to use of these agents, but only limited data are available about the risks in this populat...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15740
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To examine the association of self-reported physical activity with performance-based and self-reported physical functioning measured 3 to 5 years later. DESIGN:A population-based, longitudinal study. SETTING:The island of Oahu, Hawaii. PARTICIPANTS:Subjects were 3640 Japanese-American men older than 70 yea...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1995.tb05525.x
更新日期:1995-08-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:Patient activation encompasses the knowledge, skills, and confidence that equip adults to participate actively in their healthcare. Patients with hearing loss may be less able to participate due to poor aural communication. We examined whether difficulty hearing is associated with lower patient ac...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15833
更新日期:2019-07-01 00:00:00
abstract::The second heart sound was studied by phonocardiography and carotid tracings in 103 elderly subjects without overt evidence of heart disease. Their ages ranged from 60 to 99 years. A normal type of splitting was found in 55.3%, and a single sound in 41.7%. The difference between these percentages and those found in 60...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1977.tb00665.x
更新日期:1977-08-01 00:00:00
abstract::Forty-three elderly patients with massive bleeding of hemorrhoidal varices were treated by cryosurgery at a single outpatient session, using nitrous oxide gas, without premedication or anesthesia. The results were excellent in all but one patient, who had ulcerative colitis and required another session of cryotherapy ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1984.tb05152.x
更新日期:1984-01-01 00:00:00
abstract::Recurrent Clostridium difficile infection (CDI) is a common nosocomial infection that has a large effect on morbidity and quality of life in older adults in hospitals and long-term care facilities. Because antibiotics are often unsuccessful in curing this disease, fecal transplantation has emerged as a second-line the...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/jgs.12378
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVES:To identify factors associated with incomplete bladder emptying in older women with overactive bladder (OAB) symptoms. DESIGN:Retrospective medical records review. SETTING:Urodynamic laboratory at a large academic health care system in the southeast United States. PARTICIPANTS:Medical records from women a...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.13474
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVE:To determine medical, ophthalmologic, and demographic predictors of cognitive function scores as measured by the Telephone Interview for Cognitive Status (TICS), an adaptation of the Folstein Mini-Mental Status Exam. A secondary objective was to perform an item-by-item analysis of the TICS scores to determine...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1993.tb01883.x
更新日期:1993-05-01 00:00:00
abstract:OBJECTIVES:To assess older urban women's knowledge about sexual transmission of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and to evaluate the relationship between their HIV/AIDS knowledge level and sources of information. DESIGN:Cross-sectional survey conducted between June 2001 and...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2004.52421.x
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVES:Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection. DESIGN:Baseline data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were co...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1046/j.1532-5415.2002.50610.x
更新日期:2002-12-01 00:00:00
abstract:OBJECTIVES:To identify risk factors for five different subtypes of disability. DESIGN:Prospective cohort study. SETTING:Greater New Haven, Connecticut. PARTICIPANTS:Seven hundred fifty-four community-living residents aged 70 and older and initially nondisabled in four essential activities of daily living (bathing, d...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2009.02443.x
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVES:To describe the association between frailty and health status, the progression of frailty, and the relationship between frailty and mortality in older men. DESIGN:Cross-sectional and prospective cohort study. SETTING:Six U.S. clinical centers. PARTICIPANTS:Five thousand nine hundred ninety-three community...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1532-5415.2007.01259.x
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVES:To test the hypothesis that a micronutrient supplement can improve seroconversion after influenza immunization in older institutionalized people. DESIGN:: Randomized, double-blind, placebo-controlled study. SETTING:Nursing and residential homes in Liverpool, United Kingdom. PARTICIPANTS:One hundred sixty-...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1532-5415.2004.52005.x
更新日期:2004-01-01 00:00:00
abstract:UNLABELLED:This longitudinal study of glucose tolerance in the residents of a Jewish home for the aged (JHA) is now in its 25th year. Of 1,177 supposedly nondiabetic persons screened on admission from 1965 to 1986, 22.5% had impaired glucose tolerance (IGT), reflecting its undiagnosed prevalence among the Jewish elderl...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1989.tb06676.x
更新日期:1989-12-01 00:00:00
abstract:OBJECTIVES:To evaluate whether levels of cognitive reserve (CR), as measured using the Wechsler Adult Intelligence Scale (WAIS)-III vocabulary test, moderated longitudinal associations between cognitive functions and decline in gait speed in a community-based cohort of older adults without dementia, specifically, wheth...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2012.04193.x
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVES:To compare the association between a restrictive transfusion strategy and cardiovascular complications during hospitalization for hip fracture with the association between a liberal transfusion strategy and cardiovascular complications, accounting for all transfusions from the emergency department to postacu...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15371
更新日期:2018-07-01 00:00:00
abstract:OBJECTIVES:Insomnia, especially difficulty maintaining sleep, is prevalent among older adults and increases the incidence of falls and fractures. Moreover, the drugs used to treat it exacerbate the risk. Yet current therapies fail to address one of its most common causes in older adults: nocturia and its primary contri...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.16144
更新日期:2019-12-01 00:00:00
abstract::Despite recent gains in establishing academic sections, divisions, and departments of geriatrics in medical schools, much remains to be done to meet the medical needs of an aging population. To better understand how medical schools are educating students in geriatric-related topics, all U.S. allopathic and osteopathic...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53023.x
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVES:To study whether there are any negative or positive effects of 6 months of increased fluid intake in reasonably healthy elderly men. DESIGN:Randomized trial. SETTING:Community-based. PARTICIPANTS:One hundred forty-one healthy participants aged 55 to 75. INTERVENTION:One group was given the advice to incr...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1111/j.1532-5415.2005.00606.x
更新日期:2006-03-01 00:00:00
abstract:OBJECTIVES:To compare hearing loss screening results of four simple tests with those of hand-held audiometry. DESIGN:Cross-sectional study of individuals screened during intake for physicals and other routine procedures. SETTING:Two primary care clinics in the San Francisco Bay area. PARTICIPANTS:Older adults not we...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
doi:10.1111/jgs.15044
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVES:The specific goals of the study were to compare three health status measures among older adults for their correlations with similar scales and to examine whether extreme (positive) health states might lead to measurement problems. We also report on practical administration and response problems among older a...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1995.tb05569.x
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVES:To measure end-of-life (EOL) care preferences and advance care planning (ACP) in older Latinos and to examine the relationship between culture-based attitudes and extent of ACP. DESIGN:Cross-sectional interview. SETTING:Twenty-two senior centers in greater Los Angeles. PARTICIPANTS:One hundred forty-seven...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2010.02853.x
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVES:To examine the effect of homebound status of older persons in Israel on mortality, mental health and function, future homebound status, and institutionalization. DESIGN:Cross-sectional and longitudinal analysis using existing data sets of a national survey. SETTING:A national survey. PARTICIPANTS:The anal...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2010.03172.x
更新日期:2010-12-01 00:00:00
abstract::The implications for society of increasing life span to 120 years can only be guessed, but comparing the diversity of responses to aging in different countries may give insights into the possible effect. A European Union-funded study of the recipients of community care services in 11 European countries illustrates how...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53497.x
更新日期:2005-09-01 00:00:00
abstract::Prescription drugs are not always taken as directed. When there is a discrepancy between the use of a drug and the prescription directions, the drug-taking behavior is considered "nonadherent." To determine the extent of prescription non adherence by old persons and the reasons for nonadherence, an in-home survey was ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1982.tb05623.x
更新日期:1982-05-01 00:00:00
abstract:OBJECTIVE:To study the association of two well known risk factors for breast cancer and the association of knowledge of those risk factors with mammography utilization. DESIGN:Cross sectional: two independent random telephone surveys. SETTING:Two Northeastern metropolitan communities surveyed in 1987 and in 1989. PA...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1992.tb01848.x
更新日期:1992-08-01 00:00:00
abstract:OBJECTIVES:To determine the relationship between prealbumin, nutrient intake, and indicators of inflammation for recuperative and rehabilitative care patients. DESIGN:Prospective cohort. SETTING:Recuperative Care Unit within a Veterans Administration Nursing Home Care Unit. PARTICIPANTS:One hundred eleven men (100 w...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2008.01789.x
更新日期:2008-07-01 00:00:00