Official Disability Guidelines
PERSISTENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE
(3-digit ICD9 294)

294  Persistent mental disorders due to conditions classified elsewhere

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data187 days365 days
All absences28 days365 days

              Includes:    organic psychotic brain syndromes (chronic), not elsewhere classified
ICD-10 Code(s): F02, F03, F06, F09
ODG Treatment UR Advisor: 294
Hospital Costs: $13,206 (average of 28,630 cases)
Hospital Length Of Stay: 10.0 days
Common Procedure Codes (see ODG Treatment for auto approval codes): 99213 99214
CM Triage: Level 3 (long term planning)

Workers' Comp Costs per Claim (based on 37 claims)
Quartile25%50%75%Mean% no cost
Indemnity$26,309$67,246$103,693$69,0460%
Medical$37,320$54,353$110,463$89,5890%
Total$76,829$140,820$216,242$158,6350%

294.0  Amnestic disorder in conditions classified elsewhere

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data187 days365 days
All absences28 days365 days

              Korsakoff's psychosis or syndrome (nonalcoholic)
              Excludes:
              alcoholic:
                amnestic syndrome (291.1)
                Korsakoff's psychosis (291.1)

ICD-10 Code: F04
Causality Likelihood: Zero
Hospital Costs: $16,247 (average of 232 cases)
Hospital Length Of Stay: 8.5 days
CM Triage: Level 3 (long term planning)
Impact on Total Absence: Prevalence 0.0001% of total lost workdays

294.1  Dementia in conditions classified elsewhere

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data364 days365 days
All absences124 days365 days

              Use additional code to identify the underlying physical condition, as:
                  dementia in:
                    cerebral lipidoses (330.1)
                    epilepsy (345.0-345.9)
                    general paresis [syphilis] (094.1)
                    hepatolenticular degeneration (275.1)
                    Huntington's chorea (333.4)
                    multiple sclerosis (340)
                    polyarteritis nodosa (446.0)
                    syphilis (094.1)
              Excludes:
              dementia:
                arteriosclerotic (290.40-290.43)
                presenile (290.10-290.13)
                senile (290.0)
              epileptic psychosis NOS (294.8)

ICD-10 Code: F02.8
ODG Treatment UR Advisor: 294.1
Causality Likelihood: Zero
Hospital Costs: $17,500 (average of 349 cases)
Hospital Length Of Stay: 12.9 days
CM Triage: Level 3 (long term planning)

RTW Claims Data (Calendar-days away from work by decile)

10%20%30%40%50%60%70%80%90%100%Mean
1451124124364365365365365365236.57

Impact on Total Absence: Prevalence 0.0034% of total lost workdays; Incidence 0.04 days per 100 workers

294.10  Dementia in conditions classified elsewhere without behavioral disturbance

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data364 days365 days
All absences124 days365 days

ICD-10 Code: F02.80
Hospital Costs: $13,183 (average of 142 cases)
CM Triage: Level 3 (long term planning)
Impact on Total Absence: Prevalence 0.0003% of total lost workdays

294.11  Dementia in conditions classified elsewhere with behavioral disturbance

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data364 days365 days
All absences124 days365 days

ICD-10 Code: F02.81
ODG Treatment UR Advisor: 294.11
Hospital Costs: $20,461 (average of 207 cases)
Hospital Length Of Stay: 12.9 days
CM Triage: Level 3 (long term planning)

294.2  Dementia, unspecified

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data187 days365 days
All absences28 days365 days

294.20  Dementia, unspecified, without behavioral disturbance

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data187 days365 days
All absences28 days365 days

294.21  Dementia, unspecified, with behavioral disturbance

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data187 days365 days
All absences28 days365 days

294.8  Other persistent mental disorders due to conditions classified elsewhere

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data145 days190 days
All absences145 days190 days

              Epileptic psychosis NOS
              Mixed paranoid and affective organic psychotic states
              Use additional code for associated epilepsy (345.0-345.9)
              Excludes:
              mild memory disturbances, not amounting to dementia (310.1)

ICD-10 Code(s): F06.8, F06.0
ODG Treatment UR Advisor: 294.8
Hospital Costs: $13,012 (average of 26,671 cases)
Hospital Length Of Stay: 7.9 days
CM Triage: Level 3 (long term planning)

RTW Claims Data (Calendar-days away from work by decile)

10%20%30%40%50%60%70%80%90%100%Mean
29294444145145187187190190119.00

Impact on Total Absence: Prevalence 0.0012% of total lost workdays; Incidence 0.01 days per 100 workers

294.9  Unspecified persistent mental disorders due to conditions classified elsewhere

Return-To-Work Summary Guidelines
DatasetMidrangeAt-Risk
Claims data187 days365 days
All absences28 days365 days

              Organic psychosis (chronic)
ICD-10 Code(s): F03, F09, F06.8
Hospital Costs: $15,358 (average of 1,378 cases)
Hospital Length Of Stay: 10.0 days
CM Triage: Level 3 (long term planning)

ODG 2011 Work Loss Data Institute. All Rights Reserved.

CPT 2011 American Medical Association. All Rights Reserved.

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