Submitted My Two Cents on Centers for Medicare and Medicaid Services Proposal to Minimize the Importance of the Delirium Diagnosis Code

I found out that the Centers for Medicare and Medicaid Services (CMS) is planning to reclassify the diagnosis code for delirium, making it less serious than encephalopathy. Many clinicians are challenging it and organizations of consultation-liaison psychiatrists and the like, including me, don’t understand or agree with the plan.

Even though I’m a retired C-L psychiatrist, I put my two cents in as a comment. I told them what I used to tell others who were either my colleagues or my trainees—that delirium is a medical emergency. I support classifying delirium as a major complication or comorbidity (MCC).

Since CMS asked for supporting documents, I included a pdf of Oldham’s article:

Oldham MA, Flanagan NM, Khan A, Boukrina O, Marcantonio ER. Responding to Ten Common Delirium Misconceptions With Best Evidence: An Educational Review for Clinicians. J Neuropsychiatry Clin Neurosci. 2018 Winter;30(1):51-57. doi: 10.1176/appi.neuropsych.17030065. Epub 2017 Sep 6. PMID: 28876970.

As the authors say, “Delirium always has a physiological cause.”