Primary Care Coding Alert

Question: How should I code for a patient being evaluated for attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)? The doctor did not make a definitive diagnosis.

Nevada Subscriber

Answer: Often, a parent brings a child in for an evaluation after the child's school or another source attributes the patient's behavioral problems to possible ADD/ADHD. Typically, you can code these visits based on time because a full evaluation usually involves a lot of counseling. Use the E/M office visit codes (99201-99215) depending on the duration of the visit. For example, if the evaluation takes 25 minutes for an established patient and the physician spends over half of that face-to-face time in counseling, use 99214 (Office or other outpatient visit for the evaluation and management of an established patient physicians typically spend 25 minutes face-to-face with the patient and/or family). These evaluations can take as much as 45 minutes, and often practices can use 99215 to bill the visit. It is important for the physician to document the total time spent and how it was spent, what was discussed, etc.

Usually a definitive diagnosis of ADD or ADHD is not made until information is collected from family, teachers and psychological tests, before and after medication. If the doctor is unsure of an initial diagnosis, code the patient's symptoms. You can use 315.2 (Specific delays in development; other specific learning difficulties) or 312.00 (Undersocialized conduct disorder, aggressive type, unspecified), depending on the symptoms.

You can also use V codes to report the initial visit: V40.0 (Mental and behavioral problems; problems with learning) and V40.3 (Mental and behavioral problems; other behavioral problems). However, some insurance companies refuse to pay claims that have only V codes for the diagnosis.

When the doctor is able to diagnose ADD or ADHD, use the appropriate diagnosis code: 314.00 (Attention deficit disorder without mention of hyperactivity) or 314.01 ( with hyperactivity).