Pediatric Coding Alert

In the wake of the Clinton administrations assertion that behavioral medications, such as Ritalin, are dispensed to too many children, last month the American Academy of Pediatrics (AAP) issued long-awaited guidelines to help pediatricians diagnose and correctly code for ADHD. The new guidelines are designed for primary-care pediatricians diagnosing ADHD in children ages 6 to 12.

The Codes

The guidelines, prepared by the AAPs committee on quality improvement, subcommittee on ADHD, also will help pediatricians with diagnosis coding for the disorder. Here are the different diagnosis codes that you may use in relation to ADHD, according to the guidelines.

ICD9 314.01 (attention deficit disorder with hyperactivity)
314.00 (attention deficit disorder without mention of
hyperactivity)
314.9 (attention deficit disorder; unspecified hyperkinetic syndrome)

As per the guidelines, you should use the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to diagnose ADHD. The DSM-IV has specific clinical guidelines for assigning these diagnosis codes.

Coexisting Disorders

There are disorders which can co-exist withor exist independently fromADHD. When evaluating a child for ADHD, pediatricians should assess possible coexisting disorders.

1. Conduct disorder and oppositional defiant disorder. These disorders exist in approximately 35 percent of children with ADHD, according to research.

2. Mood disorders/depression. About 18 percent of children with ADHD also have these disorders.

3. Anxiety. Some 25 percent of children with ADHD also have anxiety disorders.

4. Learning disabilities. There is not enough research to determine the coexistence of ADHD and learning disabilities in children in primary-care settings. The rates of learning disabilities that coexist with ADHD in settings other than primary care range from 12 percent to 60 percent.