Pediatric Coding Alert

These codes describe cognition problems due to neurologic trauma. The AHA Coding Clinic restricts the use of 799.5x to conditions caused by a neurologic trauma such as traumatic brain injury. Therefore, you cannot use this code for attention or hyperactivity concerns prior to the physician reaching a definitive diagnosis of attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). The August 2010 Pediatric Coding Alert article, "ICD-9: New 'Attention Deficit' Choices Will Help Fill Gaps," indicated 799.51 could be used in signs and symptoms cases in which no official diagnosis was made. ADD is specifically excluded from 799.5x's code section, "Signs and symptoms involving cognition". "Code 799.51 (Attention or concentration deficit) is not meant to be used either as a surrogate for ADD or as a 'pre' diagnosis," says Jeffrey Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the Emergency Pediatric Group at Children's Healthcare of Atlanta at Egleston. Patients being evaluated for ADD should be coded V79.8 (Other specified mental disorders and developmental handicaps) (though you could argue that V80.09, Other neurological conditions could apply as well). Associated signs such as academic problems (V62.3) or relationship problems (313.3) can be used as secondary codes following the screening code to describe the reason for the screening. Other codes to consider when an attention deficit disorder is being considered but not yet diagnosed are 799.21 (Nervousness), 799.22 (Irritability), 799.23 (Impulsiveness), 799.24 (Emotional lability). The American Academy of Neurology created the 799.x codes to identify cognitive deficits related to a traumatic brain injury (TBI) and neurological conditions. "These codes are used to describe cognitive impairments such as problems with memory, concentration, attention, communication, and executive function," according to the ICD-9-CM C&M Agenda March 2009 and the AHA Coding Clinic, fourth quarter.