Primary Care Coding Alert

Question: The doctor’s notes say this patient has attention deficit hyperactivity disorder (ADHD) and problems with attention, but it seems like I need more information to pick the right code. For example, what is the difference between F90.0 and F98.8? The alphabetical index says F90.0 is a code for inattentive type attention-deficit hyperactivity disorder and that F98.8 is a code for attention deficit without hyperactivity, which seems like the same thing.

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Answer: If the doctor has diagnosed a patient with ADHD with inattention, that is enough information to report the diagnosis. If the physician’s notes said the patient in question had ADHD and problems with inattention, then this would suggest F90.0 is the correct code to report. If the documentation includes conflicting information, or it seems otherwise incomplete, it’s always best to confer with your provider.

However, to find the correct code, it’s best to avoid the temptation to code only from the ICD-10-CM Alphabetic Index.

The index associates F98.8 (Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence) with attention deficit disorders, but the index never gives a complete picture, so it’s best to instead use the index as a starting place to determine the most accurate code(s) to report the diagnosis of a specified disorder rather than relying solely on the index. Searching for attention deficit disorder or attention deficit hyperactivity disorder will direct you to Chapter 5, Mental, Behavioral and Neurodevelopmental Disorders (F01-F99), where you can find more detailed information about all the codes in question.

When you find category F98.- (Other behavioral and emotional disorders with onset usually occurring in childhood and adolescence), then go down the tabular list to F98.8 (Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence), you’ll notice neither level specifically excludes ADHD, but neither one includes it. ADHD has its own set of codes within Chapter 5, and they are as follows:

• F90.0 (Attention-deficit hyperactivity disorder, predomi­nantly inattentive type)
• F90.1 (Attention-deficit hyperactivity disorder, predomi­nantly hyperactive type)
• F90.2 (Attention-deficit hyperactivity disorder, combined type)
• F90.8 (Attention-deficit hyperactivity disorder, other type)
• F90.9 (Attention-deficit hyperactivity disorder, unspecified type)

The ICD-10-CM index will also lead you to the F90.- code family with a little digging. As noted, if you start with “Attention (to)” in the index, you will see underneath that “deficit disorder or syndrome,” which points to F98.8. However, indented under that entry in the index is “with hyperactivity,” which says to see “Disorder, attention-deficit hyperactivity.” When you go to “Disorder” in the index and look at “attention-deficit hyperactivity” underneath it, the index points you to F90.9 as a starting place.