May 16, 2016

Accurate ICD-10-CM Coding for ADHD Assists with Research and Data Collection

By
EDITOR’S NOTE: Attention deficit hyperactivity disorder (ADHD) continues to make news. “Science Daily” reported recently that a new study from Aarhus University documented that there is some truth to the claim made by parents of children with ADHA that their children have more trouble falling to asleep than other children. Kimberly Carr goes beyond the headlines to report this story.

Join Chuck Buck and Kim Charland as they welcome Carmen D. Zorrilla, MD, professor of Obstetrics and Gynecology at the University of Puerto Rico on Talk Ten Tuesday, today at 10 A.M. ET. Dr. Zorrilla heads up the Zika investigations of infected women in Puerto Rico. She will report on the growing crisis that is Zika.

In recent years there has been growing awareness of attention deficit hyperactivity disorder (ADHD), particularly when it occurs in children. One in three children in the United States with ADHD are diagnosed before the age of 6, according to the Centers for Disease Control and Prevention (CDC). In fact, ADHD is one of the most commonly diagnosed childhood behavioral and emotional disorders, which often continue into adulthood.

Approximately 11 percent of children ages 4 through 17 (i.e., 6.4 million individuals) have been diagnosed with ADHD as of 2011, according to the CDC. When left untreated, ADHD can have serious consequences. Children with the condition may fall behind in school, have difficulty maintaining friendships, find themselves unable to accomplish basic tasks, or have conflicts with others.

“Parents may feel overwhelmed with decisions about their child’s treatment for ADHD, but healthcare providers, therapists, and families can all work together to help the child thrive,” CDC Principal Deputy Director Anne Schuchat said in a recent article about ADHD that was published on the U.S. Department of Health and Human Services (HHS) website. “Parents of young children with ADHD may need support, and behavior therapy is an important first step. It has been shown to be as effective as medicine, but without the risk of side effects.” 

Unfortunately, the recommended first line of treatment for ADHD (i.e., behavior therapy) is often underused, according to the CDC. Only 40-50 percent of young children with ADHD receive psychological services. Many parents resort immediately to stimulant or non-stimulant medication, which could have detrimental side effects.

Three types of ADHD 

The CDC provides many resources for parents as well as clinical guidelines for providers. CHADD, a national resource on ADHD, also offers resources for teachers to help students with ADHD. It’s important for parents, providers, and teachers to be able to recognize the three types of ADHD: 

Inattentive: Individuals with this type of ADHD fail to pay close attention to details and make careless mistakes in schoolwork and other activities. They have difficulty staying focused, do not follow instructions, and have trouble organizing and completing tasks. They may often misplace or forget about items, exhibit poor listening skills, and become easily distracted by events happening around them. Ultimately, the manifestations of inattention can interfere with an individual’s ability to complete simple daily activities. 

Hyperactivity and impulsivity: Individuals with this type of ADHD fidget and are often unable to sit still. They have difficulty playing or working quietly and are constantly moving or talking excessively. These individuals also have difficulty waiting to take a turn, and they often interrupt others. 

Combined: These individuals have symptoms of inattention, hyperactivity, and impulsivity. 

For a clinical diagnosis of ADHD, an individual must exhibit six or more symptoms of one of the types of ADHD and also meet each of the following three criteria: 

  1. The symptoms caused problems before the age of 7.
  2. The behavior is abnormal for a non-ADHD child of the same age.
  3. The symptoms have lasted longer than six months, and they impair school, work, home life, or relationships in more than one setting. 
Clinical documentation requirements for ADHD 

Clinical documentation must clearly differentiate ADHD from the following conditions: 

  • Hyperkinesia
  • Hyperkinetic syndrome
  • Conduct disorders
  • Simple disturbances of activity and attention 
Clinical documentation must also document the specific type of ADD:

  • Predominantly inattentive type
  • Predominantly hyperactive-impulsive type
  • Combined type 
Coding ADHD in ICD-10

ICD-10-CM category F90.- includes ADHD as well as attention deficit syndrome with hyperactivity. It excludes anxiety disorders (F40.- and F41.-), mood (affective) disorders (F30-F39), pervasive developmental disorders (F84.-), and schizophrenia (F20.-). More specifically, the F90.- category includes the following ICD-10-CM codes: 

  • F90.0 (ADHD, predominantly inattentive type): Some level of hyperactivity-impulsivity may be present in these individuals; however, the majority of symptoms must be associated with inattention. Attention deficient disorder without hyperactivity is also indexed under this code. 
  • F90.1 (ADHDpredominantly hyperactive-impulsive type): Although some degree of inattention may also be present, these individuals are primarily hyperactive. 
  • F90.2 (ADHD, combined type): Symptoms of both types are present, but neither is predominant. Most diagnoses of ADHD are this type.
  • F90.8 (ADHD, other type): This includes all the hyperkinetic syndromes.
  • F90.9 (ADHD, unspecified type or NOS): Report this code when the physician does not specify the type of ADHD. However, coders should query for more information before defaulting to this code.
When reported as a principal diagnosis, a code from category F90.- groups to MS-DRG 886 (behavioral and developmental disorders). None of the codes in this category are CCs or MCCs; however, these codes do help convey severity of illness (SOI) and risk of mortality (ROM) of the patient.

Conditions included in the F90.- category are indexed in the ICD-10 code book under “disorders,” then “attention-deficit with or without hyperactivity.” The terms “adolescent,” “adult,” and “child” are nonessential modifiers, meaning they may or may not be present in the statement of the disease, and they don’t affect code assignment. 

Category F90.- includes a note at the beginning indicating that these codes may be used regardless of the patient’s age. Note that these disorders generally have onset during childhood, but they may continue through a patient’s life. In some cases, patients may not be diagnosed until adulthood. 

Coding and sequencing for ADHD depends on the physician’s documentation, the application of the ICD-10-CM Coding Guidelines, and any relevant AHA Coding Clinic

To learn more about ADHD, visit the CDC’s website as well as CHADD, the national resource on ADHD.
Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Kim Carr, RHIT, CCS, CDIP, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer

Kim Carr brings more than 30 years of health information and clinical documentation improvement management experience and expertise to her role as Director of Clinical Documentation, where she provides oversight for auditing and documentation improvement for HRS clients. Prior to joining HRS, Kim worked as a consultant implementing CDI programs in varied environments such as level-one trauma centers, small community hospitals and all levels in between.

Before joining the consultant arena, Kim served as Manager of CDI in an academic level-one trauma center. She was responsible for education and training for physicians and clinical documentation specialists. Over the past 30 years, Kim has held several HIM positions; including HIM Coding Educator, Quality Assurance/Utilization Management Coordinator, DRG Coding Coordinator and Coding Manager. Kim holds a degree in Health Information Management and is a member of AHIMA, THIMA, ACDIS and AAPC.

Related Stories