Documenting and Coding Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurological condition that is characterized by behavioral problems related to attention, impulsivity and/or hyperactivity that interfere with the person’s day-to-day functioning or development. Also known as attention deficit disorder (ADD), the condition can continue through adolescence and adulthood. If left untreated, ADHD can lead to several serious consequences. Neuropsychologists, clinical psychologists, psychiatrists and other specialists treating patients with this behavioral disorder must know the ICD-10 codes to report the condition correctly. Outsourced medical billing services are a practical option to ensure timely, error-free claim submission for appropriate reimbursement.

According to 2017 statistics from the Centers for Disease Control and Prevention (CDC), there are an estimated 6.4 million children diagnosed with ADHD in the United States. The exact causes of attention deficit hyperactivity disorder are unknown. However, genetics and neurobiological factors are expected to cause this condition. Common symptoms include – difficulty staying focused, difficulty paying attention, over-activity and difficulty controlling behavior. This common childhood disorder can affect academic achievement, well-being and social interactions.

Treatment for ADHD for children and adults will vary depending on the patient’s age and type of symptoms.

Types of Attention Deficit Disorders (ADD)

Attention deficit disorders (ADD) are of three types –

• Inattentive – Inattentive ADHD means a person depicts enough symptoms of inattention (or easy distractibility) but isn’t hyperactive or impulsive.
• Hyperactive/impulsive – This type occurs when a person depicts symptoms of hyperactivity and impulsivity but not inattention.
• Combined – Combined ADHD is when a person has all the three symptoms of inattention, hyperactivity, and impulsivity.

Generally, adults with the predominantly inattentive form of ADHD first develop it during childhood. Since children with this form of ADHD are not hyperactive, the condition may remain unrecognized until they reach their adolescence or adulthood. The condition is more common in males than females, and females with ADHD are more likely to have problems with inattention. Studies suggest that ADHD is caused by the interaction between genes and factors such as exposure to environmental toxins (during pregnancy or at a young age), low birth weight, brain injury, and cigarette smoking, alcohol use or drug use during pregnancy,.

Symptoms

As per the American Psychiatric Association’s diagnostic manual, there are nine symptoms associated with the inattention problems. Although most people suffering from this disorder experience many of these symptoms at times, people with the predominantly inattentive form of ADHD show at least six out of the nine symptoms. These symptoms may cause severe disruptions in their daily activities. The common symptoms of a person with ADHD include –

• Difficulty sustaining attention at work or play
• Often loses materials needed to complete tasks or activities
• Gets easily distracted by outside stimuli
• Frequently puts off or avoids tasks that require sustained attention
• Frequently does not pay close attention to details or makes careless mistakes at work, school or other tasks
• Frequently does not follow given instructions or fails to complete work or school assignments, chores or other activities, (even though the person understands what is expected)
• Face problems organizing chores or activities
• Becomes forgetful when performing routine chores
• Appears not to be listening even when spoken to directly

The severity of symptoms can range from mild to severe, depending on a person’s unique psychology. Some people may be mildly inattentive while performing certain tasks, while others may be or hyperactive. On the other hand, some others may experience more severe symptoms such as depression, anxiety, or a learning disability that can directly affect their school, work or social situations or interactions.

Diagnosis, Treatment and Clinical Documentation of ADHD

There is no single, definitive test for diagnosing this neuro-behavioral disorder. Diagnosis begins with a interview and medical history evaluation to obtain relevant, detailed information about changes in past and present behavior patterns. As part of the diagnostic interview, clinical psychologists will include questions about how the patient functions at home, school or work. Patients will be asked to fill out a checklist with symptoms. A detailed physical examination will be performed to rule out symptoms of other medical conditions resembling those of ADHD. In addition, different types of psychological tests may be ordered to rule out the presence of co-existing conditions like anxiety or depression.

Determining the type of ADHD is one of the most important steps towards finding the right treatment approach. In order to get an accurate diagnosis, it is very important to discuss all specific symptoms with your physician. There are different approaches for treating attention deficit disorders, but generally a combination of medications and behavioral therapy may yield in the best results. Prescription medications like psycho stimulants, antidepressants, and non-stimulant drugs can help patients with ADD to stay on-task and focused. Behavior modifications or other forms of therapy will also be administered to help patients identify problem behaviors, and create and implement strategies for changing their behavioral pattern.

Documentation Requirements

A qualified professional must conduct the evaluation. Professionals conducting assessments and rendering diagnoses of ADHD must undergo comprehensive training and have relevant experience in differential diagnosis and the full range of psychiatric disorders. Psychologists, neuropsychologists, psychiatrists, and other relevantly trained physicians are generally considered qualified to evaluate and diagnose ADHD.

According to the guidelines from the American Academy of Pediatrics (AAP), a diagnosis of ADHD requires documenting the fact that the child has suffered difficulties in more than one major setting, for instance, in school or home.

For a clinical diagnosis of ADHD, an adult must exhibit six or more symptoms (of one of the types of ADHD) that must have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level. Additional criteria include –

• Symptoms must have caused problems before the age of 7.
• The behavior is abnormal for a non-ADHD child of the same age.
• Symptoms of hyperactivity/impulsivity which were present in childhood, and the current symptoms which have been present for at least the past six months and which impair functioning in two or more settings (e.g. school, work, and home) must also be identified
• A history of individual presenting attentional symptoms and evidence of current impulsive/hyperactive or inattentive behaviors.

Documentation to authenticate the diagnosis should also include evidences of early and current impairment. Evidence of current impairment can be a history of the presenting symptoms and a diagnostic interview with information from a variety of sources such as history of presenting symptoms, developmental history, family history for presence of ADHD and relevant medical and medication history, and relevant history of prior therapy.

ICD-10 Coding

The diagnostic tests and treatment procedures for ADHD must be correctly documented using the right codes. An experienced medical billing company can help physicians report the correct billing codes. ICD-10 codes for ADHD come under category F90 which includes – ADHD as well as attention deficit syndrome with hyperactivity.

F90 – Attention-deficit hyperactivity disorders

• F90.0 – Attention-deficit hyperactivity disorder, predominantly inattentive type (Some level of hyperactivity-impulsivity may be present in these individuals; however, the greater part of symptoms must be related to inattention. Attention deficient disorder without hyperactivity is also indexed under this code.)
• F90.1 – Attention-deficit hyperactivity disorder, predominantly hyperactive type (Although some degree of inattention may also be present, these individuals are primarily hyperactive)
• F90.2 – Attention-deficit hyperactivity disorder, combined type (Symptoms of both types are present, but neither is predominant)
• F90.8 – Attention-deficit hyperactivity disorder, other type (This includes all the hyperkinetic syndromes)
• F90.9 – Attention-deficit hyperactivity disorder, unspecified type (This code is reported when the physician does not specify the type of ADHD).

All the conditions included in the F90 category are indexed in the ICD-10 code book under the heading – “disorders,” then “attention-deficit with or without hyperactivity.” This category also includes a note that indicates that these codes may be used regardless of the patient’s age.

Medical billing and coding for attention deficit hyperactivity disorder can be complex, as there are different codes associated with the condition. By outsourcing these tasks to a reliable medical billing and coding company that offers the services of AAPC-certified coding specialists, healthcare practices can ensure correct and timely medical billing and claims submission.