ICD-10 Coding for Dementia Treated with Rexulti (Brexpiprazole)
The appropriate ICD-10 code for dementia treated with Rexulti (brexpiprazole) would be F03 (Unspecified dementia) with an additional code for the medication, such as Z79.899 (Other long term (current) drug therapy).
Primary Dementia Diagnosis Codes
When coding for dementia treated with Rexulti, the primary diagnosis should reflect the specific type of dementia:
- F01.50 - Vascular dementia without behavioral disturbance
- F01.51 - Vascular dementia with behavioral disturbance
- F02.80 - Dementia in other diseases classified elsewhere without behavioral disturbance
- F02.81 - Dementia in other diseases classified elsewhere with behavioral disturbance
- F03.90 - Unspecified dementia without behavioral disturbance
- F03.91 - Unspecified dementia with behavioral disturbance
- G30.0 - Alzheimer's disease with early onset
- G30.1 - Alzheimer's disease with late onset
- G30.8 - Other Alzheimer's disease
- G30.9 - Alzheimer's disease, unspecified
Important Considerations for Rexulti Use in Dementia
It's critical to note that Rexulti (brexpiprazole) has recently been approved specifically for agitation associated with dementia due to Alzheimer's disease 1. This is significant as it's the first medication approved by the FDA for this specific indication.
When using Rexulti for dementia:
- Add F06.4 (Anxiety disorder due to known physiological condition) or R45.1 (Agitation) if treating agitation symptoms
- Include Z79.899 (Other long term (current) drug therapy) to indicate medication treatment
Cautions and Contraindications
The use of antipsychotics, including Rexulti, in dementia requires careful consideration:
- The Mayo Clinic guidelines indicate that antipsychotics for cognitive behavioral problems in dementia should be avoided when possible 2
- There is an FDA Black Box warning regarding increased mortality risk when antipsychotics are used for dementia 2
- Atypical antipsychotics like Rexulti should not be used as first-line management for behavioral symptoms of dementia 2
Coding for Specific Clinical Scenarios
Alzheimer's dementia with agitation treated with Rexulti:
- G30.9 - Alzheimer's disease, unspecified
- F02.81 - Dementia in other diseases classified elsewhere with behavioral disturbance
- Z79.899 - Other long term (current) drug therapy
Unspecified dementia with behavioral disturbance treated with Rexulti:
- F03.91 - Unspecified dementia with behavioral disturbance
- Z79.899 - Other long term (current) drug therapy
Clinical Evidence for Rexulti in Dementia
Recent clinical trials have demonstrated that:
- Brexpiprazole 2 mg/day showed statistically significant improvement in agitation symptoms compared to placebo, with approximately 5-point greater reduction on the Cohen-Mansfield Agitation Inventory 1, 3
- Common adverse reactions include dizziness, headaches, insomnia, nasopharyngitis, somnolence, and urinary tract infections 1
- Safety analysis from pooled data of over 1,000 participants showed brexpiprazole appears generally well-tolerated for up to 24 weeks 4
Monitoring Requirements
When coding for follow-up visits for patients on Rexulti for dementia:
- Use Z51.81 (Encounter for therapeutic drug level monitoring) when appropriate
- Consider adding Z79.899 (Other long term (current) drug therapy) to indicate ongoing medication management
Remember that proper documentation of the specific dementia type, presence of behavioral disturbances, and medication management is essential for accurate coding and appropriate patient care.