Proposed Separate ICD 10 Coding for Anosognosia (Neurological Unawareness of Illness)

Submitted for the Sept. 12-13, 2023 Meeting.

Proposal for Anosognosia Classification in the ICD-10-CM Coding System - Revised

Anosognosia is neuropsychiatric condition in which patients remain insistent that they do not

have a severe illness. 1 Anosognosia is highly prevalent, affecting 50-98% of individuals with

schizophrenia, approximately 40% with bipolar disorder, and about 80% with Alzheimer's

disease. 3 It also impacts 10-18% of those who develop one-sided paralysis after a stroke and has

been found in patients with aphasia, Huntington's, Parkinson's, frontotemporal dementia, and

severe traumatic brain injury. 4 Recognized as a medical condition for over a century, 5 anosognosia

is distinct from psychological denial, arising from damage to the brain's self-image updating

mechanism. 6 Consequently, patients are neurologically incapable of perceiving loss of impaired

neurological or neuropsychological function. 7

Anosognosia substantially hinders treatment, compliance, therapist alliance development, and

rehabilitation. 8 Treatment effectiveness for mild to moderate dementia is impaired in those with

anosognosia. 9 Moreover, caregiver burden for Alzheimer's patients significantly increases with

anosognosia. 10 Treating patients with anosognosia often necessitates unique, varied approaches 11

and imposes additional responsibilities on medical professionals to overcome patient unawareness

of their limitations. 12 Patients are often genuinely puzzled as to why family and caregivers want

them to take medication and to participate in other treatments. As a result, patients often refuse

them all. Untreated mental illness has harsh consequences, including suicide, rampage shootings,

and abject disabilities in highly capable individuals. Such diagnosis will also help the courts in

assessing whether involuntary commitment is appropriate.

Considering the significant clinical challenges anosognosia imposes on medical professionals,

caregivers, and patients, and its prevalence, a unique ICD-10-CM code is being requested for this

condition. The condition is currently an inclusion term at code R41.89, Other symptoms and signs

involving cognitive functions and awareness. It is of the opinion of the submitter that the

classification is inadequate, and a unique code is needed.

References:

1 Acharya, A. B., & Sánchez-Manso, J. C. (2022, June 7). Anosognosia - StatPearls - NCBI Bookshelf. Na>onal Library of

Medicine. Retrieved from hIps://www.ncbi.nlm.nih.gov/books/NBK513361/

2 2023 ICD-10-CM diagnosis code R41.89. (n.d.). Retrieved from hIps://www.icd10data.com/ICD10CM/Codes/R00- R99/R40-

R46/R41-/R41.89

3 Anosognosia: What it is, causes, symptoms & treatment. Cleveland Clinic. (n.d.). Retrieved from

hIps://my.clevelandclinic.org/health/diseases/22832-anosognosia

4 Prigatano, G. P. (2009). Anosognosia: Clinical and ethical considera>ons. Current Opinion in Neurology, 22(6), 606– 611.

DOI: 10.1097/wco.0b013e328332a1e7

5 Weinstein, E. A. (1950). The Syndrome of Anosognosia. Archives of Neurology and Psychiatry, 64(6): 772-791, p. 772 n. 1. DOI:

10.1001/archneurpsyc.1950.02310300019002

6 Cleveland Clinic, supra; Prigatano, supra.

7 Prigatano, supra.

8 Id.

1

9 Koltai, C. C., Welsh-Bohmer, K. A., Schmechel, D. E. (2001). Influence of anosognosia on treatment outcome among demen>a

pa>ents. Neuropsychological RehabilitaEon: An InternaEonal Journal, 11:3-4, 455-475, DOI: 10.1080/09602010042000097

10 Turró-Garriga, O., Garre-Olmo, J., Vilalta-Franch, J., Conde-Sala, J. L., de Gracia Blanco, M., & López-Pousa, S. (2012).

Burden associated with the presence of Anosognosia in Alzheimer's disease. InternaEonal Journal of Geriatric Psychiatry, 28(3),

291–297. DOI: 10.1002/gps.3824

11 Jenkinson, P. M., Preston, C., Ellis, S. J. (2011) Unawareness aher stroke: A review and prac>cal guide to understanding,

assessing, and managing anosognosia for hemiplegia, Journal of Clinical and Experimental Neuropsychology, 33:10, 1079-1093,

DOI: 10.1080/13803395.2011.596822

12 Id.; Moro, V., Scandola, M., Bulgarelli, C., Avesani, R., & Fotopoulou, A. (2014). Error-based training and emergent

awareness in Anosognosia for Hemiplegia. Neuropsychological RehabilitaEon, 25(4), 593–616. DOI:

10.1080/09602011.2014.951659

TABULAR MODIFICATIONS

R41 Other symptoms and signs involving cognitive functions and awareness

R41.8 Other symptoms and signs involving cognitive functions and awareness

New Code R41.85 Anosognosia

R41.89 Other symptoms and signs involving cognitive functions and

awareness

Delete Anosognosia