Pediatric Coding Alert

Question: Our pediatrician documented a patient with attention deficit hyperactivity disorder (ADHD) with attention problems. The ICD-10 Alphabetic Index lists a number of possible code choices. How do I assign the correct one, and when would I choose F98.8 over one of the F90.- codes, especially as the synonyms for F98.8 do not mention attention deficit disorder (ADD)?

AAPC Forum Participant

Answer: Assigning the correct ADHD or attention deficit disorder (ADD) diagnosis code is not as easy as following the following ICD-10 Alphabetic Index directions, as current understanding of the conditions has rendered a purely ADD diagnosis outdated.

Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM), there are three types of ADHD: predominantly inattentive presentation, predominantly hyperactive-impulsive presentation, and combined presentation.

The first type of ADHD is what providers used to refer to as ADD. So, rather than following the ICD-10 Alphabetic Index entry for Disorder, attention-deficit without hyperactivity, which directs you to F98.8 (Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence), current thinking leads you to use F90.0 (Attention-deficit hyperactivity disorder, predominantly inattentive type).

To code the other types of ADHD, you would turn to F90.1 (Attention-deficit hyperactivity disorder, predominantly hyperactive type) or F90.2 (Attention-deficit hyperactivity disorder, combined type) depending on provider documentation.

The F90.- codes also feature two other codes — F90.8 (Attention-deficit hyperactivity disorder, other type) or F90.9 (Attention-deficit hyperactivity disorder, unspecified type). You should not use either of these codes to document ADD, as both specifically mention hyperactivity in their descriptors. But before you assign any of these codes, make sure you query your pediatrician to make sure code assignment aligns precisely with the diagnosis provided.