Pediatric Coding Alert

From ADHD to separation anxiety, see if you can select the correct diagnosis code.

Pediatricians are often consulted to check on a patient’s mental health condition, and these practices frequently see diagnoses of attention deficit hyperactivity disorder (ADHD), anxiety, depression and other mental, behavioral, and neurodevelopmental issues. Ensure that you know how to report mental health diagnoses by reading these five quiz questions and determining the answers.

Question 1: A patient presents with ADHD but the pediatrician notes that the patient is not hyperactive, but instead suffers from inattentive ADHD.

Question 2: A six-year-old male patient comes to the office and his mother says he makes a grunting sound every few minutes. She asks the physician to determine whether the boy has Tourette’s disorder, but the physician doesn’t find anything wrong with the child other than the vocal tic.

Question 3: A parent brings in her one-year-old child for evaluation, telling the pediatrician that she recently started taking the child to day care and the baby screams throughout the day. When the mother picks up the baby every afternoon, he stops crying. The pediatrician diagnoses the child with separation anxiety.

Question 4: The pediatrician diagnoses a seven-year-old patient with autism. Although he is confident that the patient has autism, he believes that it’s possible that the patient has Asperger’s syndrome and refers the patient for further testing. Which diagnosis code should you report?

Question 5: A patient presents to the office missing some of the hair on the left side of her head. Her mother cannot figure out what the cause is, but after talking to the patient, the doctor determines that she has been compulsively pulling her hair out.

Answers to the Coding Quiz:

Answer 1: Although it seems unusual to brand a patient with ADHD if they don’t have a hyperactivity component, you would be correct in looking to the ADHD section of the ICD-10 manual, which is F90 (Attention-deficit hyperactivity disorders).

When a patient has ADHD that’s predominantly inattentive rather than hyperactive, report F90.0 (Attention-deficit hyperactivity disorder, predominantly inattentive type).

Answer 2: If the physician diagnoses the child with a chronic vocal tic disorder, the appropriate code is F95.1 (Chronic motor or vocal tic disorder). Some coders may overlook this code if the patient doesn’t have a motor tic, but keep in mind the use of the word “or” in the descriptor, meaning you can use it for either a vocal tic or a motor tic.

You should avoid reporting the Tourette’s disorder diagnosis (F95.2) because the pediatrician did not diagnose the patient with the disorder. If the doctor determines that the patient’s vocal tic is from a different tic disorder that isn’t listed in the ICD-10 manual, report F95.8 (Other tic disorders).

Answer 3: In this situation, you should report F93.0 (Separation anxiety disorder of childhood). This code falls under the section “Emotional disorders with onset specific to childhood.” You should not report this code if the pediatrician offers a more definitive diagnosis such as social phobia or phobic anxiety disorder of childhood.

Answer 4: In this case, you should report F84.0 (Autistic disorder) because the only definitive diagnosis the pediatrician has assigned is autism. If the physician later determines that the child has Asperger’s syndrome, you will then report F84.5 (Asperger’s syndrome), but you should not bill this diagnosis code until you have a confirmed diagnosis.

Answer 5: Patients who have impulse disorders are coded to the F63 category, and in this case, the patient has trichotillomania, or hair plucking, which you would report with F63.3 (Trichotillomania).