What is the ICD10 code for a geriatric patient started on Depakote (valproate) for behavioral issues?

ICD-10 Coding for Behavioral Symptoms in Geriatric Patients on Depakote

The appropriate ICD-10 code depends on the underlying etiology of the behavioral symptoms, not the medication prescribed. The most common scenarios in geriatric patients started on Depakote for behaviors include behavioral disturbances associated with dementia or other psychiatric conditions.

Primary Diagnostic Codes Based on Clinical Context

If Behavioral Symptoms are Due to Dementia:

• F03.91 - Unspecified dementia with behavioral disturbance 1
• This is the most commonly used code when behavioral symptoms (agitation, aggression, combativeness) occur in the context of dementia of any type 1
• Use this code when the patient has documented dementia (Alzheimer's, vascular, Lewy body, etc.) and the behaviors are manifestations of that dementia 1

If Behavioral Symptoms are Due to Delirium:

• F05 - Delirium due to known physiological condition 2
• Use when acute confusion and agitation are present with fluctuating consciousness 2
• Requires identification and coding of the underlying medical cause (infection, metabolic disturbance, etc.) 2

If Behavioral Symptoms are Primary Psychiatric:

• F31.9 - Bipolar disorder, unspecified (if using Depakote for mood stabilization) 3
• F60.3 - Borderline personality disorder (if treating impulsivity and mood instability) 4
• F34.0 - Cyclothymic disorder (for chronic mood instability)

Critical Coding Considerations

Documentation Requirements:

• The medical record must clearly document the specific behavioral symptoms being treated (agitation, aggression, combativeness, mood lability) 1
• Link the behaviors to the underlying diagnosis (dementia, delirium, mood disorder) 1
• Document that non-pharmacological interventions were attempted before medication initiation, as this supports medical necessity 1

Common Pitfall to Avoid:

• Do not use R45.1 (Restlessness and agitation) as a primary diagnosis when the behaviors are clearly related to an underlying dementia or psychiatric condition 1
• R45.1 should only be used when behavioral symptoms occur without a clear underlying psychiatric or neurological diagnosis
• Using symptom codes instead of disease codes may result in claim denials or inadequate reimbursement

Additional Required Codes:

• Z79.899 - Long-term (current) use of other medications (for ongoing Depakote therapy)
• Code any underlying medical conditions contributing to behaviors (UTI, pain, constipation) as these are often triggers 2, 1
• For females of childbearing potential on Depakote, consider adding Z79.3 (Long-term use of hormonal contraceptives) if pregnancy prevention program is documented 5

Specific Clinical Scenarios

Scenario 1: Alzheimer's Disease with Agitation

• Primary: G30.9 - Alzheimer's disease, unspecified
• Secondary: F02.81 - Dementia in other diseases classified elsewhere with behavioral disturbance 1

Scenario 2: Vascular Dementia with Aggression

• Primary: F01.51 - Vascular dementia with behavioral disturbance 1

Scenario 3: Agitated Delirium (e.g., from UTI)

• Primary: F05 - Delirium due to known physiological condition 2
• Secondary: N39.0 - Urinary tract infection, site not specified (or specific infection code)

Scenario 4: Mood Disorder in Elderly

• Primary: F31.9 - Bipolar disorder, unspecified 3
• Or F34.81 - Disruptive mood dysregulation disorder (if chronic irritability)

Justification for Depakote Use

The American Academy of Family Physicians recognizes Depakote (divalproex sodium) as a mood-stabilizing agent for control of severe agitated, repetitive, and combative behaviors, with initial dosing of 125 mg twice daily, titrated to therapeutic blood levels of 40-90 mcg/mL 2. It is generally better tolerated than other mood stabilizers in geriatric patients, though liver enzyme monitoring is required 2. The medication is appropriate for behavioral symptoms when antipsychotics are contraindicated or ineffective 1.