Pediatric Coding Alert

Key: Avoid 'labeling' a patient with ADD or ADHD if you haven't yet reached a diagnosis.

Puzzled about how to report the commonly-seen "pre-ADD" diagnosis? Until the ICD-9 code set (or its ICD-10 equivalent after Oct. 1, 2013) introduces a code for a "pre" diagnosis of attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD), you should continue to report the signs and symptoms that prompted the patient's visit.

In the November 2011 Issue of Pediatric Coding Alert, we reminded coders that new code 799.51 (Attention or concentration deficit) was created to report cognitive deficits related to a traumatic brain injury or neurological condition--but not as a pre-ADD diagnosis. This prompted questions from our readers, who asked what they should use when patients present with conditions that signal that the patient is "pre-" ADD or ADHD.

The lowdown: If your physician has not definitively diagnosed the patient with ADD, ADHD, or another disorder, you should code the office visit using the signs and/or symptoms that prompted the visit. The Official ICD-9-CM Coding Guidelines note, "Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider."

A physician should not use the ADD or ADHD codes until she is confident of the diagnosis, recognizing that ICD coding is considered "labeling. If you're coding the chart of a patient who presents with pre-ADD or pre-ADHD symptoms, the following codes may be appropriate: