ADHD, or Attention Deficit Hyperactivity Disorder, is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It often begins in childhood and can persist into adulthood. ADHD diagnosis and treatment relies on using certain medical codes for billing and reimbursement purposes. Let’s take a closer look at ADHD coding.
What are Medical Codes?
Medical codes are alphanumeric codes used by healthcare providers and medical coders to represent diagnoses, procedures, and services. They provide a standardized way to document and communicate health information for billing, reimbursement, data analysis, and reporting.
Some common medical coding systems used in the US include:
– ICD-10-CM – Used to code medical diagnoses like ADHD. Maintained by the World Health Organization (WHO).
– CPT codes – Used to code medical procedures and services. Maintained by the American Medical Association (AMA).
– HCPCS codes – Used to code procedures, supplies, and services not covered by CPT. Maintained by Centers for Medicare and Medicaid Services (CMS).
Why are Codes Important for ADHD?
Using proper medical codes for ADHD billing and documentation is crucial because:
– They specify the exact ADHD diagnosis.
– They provide information needed for insurance claims processing.
– They justify the need for ADHD medications, therapy, accommodations, etc.
– They allow tracking of ADHD prevalence, comorbidities, costs, etc. for research.
In short, ADHD codes facilitate communication, billing, reimbursement, and data analysis in healthcare.
ADHD ICD Diagnosis Codes
The ICD-10-CM manual contains specific codes to identify different types of ADHD diagnoses. These codes are to be used by healthcare providers like psychiatrists, pediatricians, and psychologists to code ADHD during clinical encounters.
ADHD Predominantly Inattentive Type
This subtype of ADHD is characterized by significant problems with attention span but not hyperactivity.
| Code | Description |
|---|---|
| F90.0 | Attention-deficit hyperactivity disorder, predominantly inattentive type |
ADHD Predominantly Hyperactive Type
This ADHD subtype features significant hyperactivity and impulsivity but not inattention.
| Code | Description |
|---|---|
| F90.1 | Attention-deficit hyperactivity disorder, predominantly hyperactive type |
ADHD Combined Type
In this most common ADHD subtype, affected individuals show symptoms of both inattention and hyperactivity/impulsivity.
| Code | Description |
|---|---|
| F90.2 | Attention-deficit hyperactivity disorder, combined type |
Other Specified ADHD
This code is used when a presentation meets general ADHD criteria but does not fit one of the three subtypes above.
| Code | Description |
|---|---|
| F90.8 | Attention-deficit hyperactivity disorder, other type |
Unspecified ADHD
Used when the clinician doesn’t specify the ADHD subtype.
| Code | Description |
|---|---|
| F90.9 | Attention-deficit hyperactivity disorder, unspecified type |
Billing and Coding Guidelines
When coding for ADHD, there are some guidelines to keep in mind:
Specify Presentation
Always code the specific ADHD presentation – inattentive, hyperactive, or combined type – if known. Avoid unspecified F90.9 if possible.
Document Severity
Note the severity – mild, moderate, or severe. This can help convey impact and justify treatment.
Include Comorbidities
Many other conditions like learning disabilities, anxiety, depression etc often co-occur with ADHD. Always code any comorbid diagnoses.
Code Follow-up Visits
Remember to code ADHD on subsequent visits, not just the initial diagnosis visit.
Distinguish from Other Disorders
Distinguish ADHD symptoms from similar presentations like conduct disorder, mood disorder, or personality change.
Common ADHD Medication Codes
ADHD medications require proper coding for pharmacy claims. Here are some common ADHD prescription drug codes:
Methylphenidate Products
Methylphenidate stimulants like Ritalin are first-line ADHD medications.
| Medication | Code |
|---|---|
| Methylphenidate tablets | CII, NDC varies |
| Methylphenidate ER tablets | CII, NDC varies |
| Methylphenidate solution | CII, NDC varies |
Amphetamine Products
Amphetamines like Adderall and Vyvanse are also commonly prescribed for ADHD.
| Medication | Code |
|---|---|
| Mixed amphetamine salts tablets | CII, NDC varies |
| Lisdexamfetamine capsules | CII, NDC varies |
| Dextroamphetamine tablets | CII, NDC varies |
Non-Stimulants
Non-stimulant medications like atomoxetine and alpha-agonists may also be used.
| Medication | Code |
|---|---|
| Atomoxetine capsules | CII, NDC varies |
| Guanfacine ER tablets | CII, NDC varies |
| Clonidine ER tablets | CIV, NDC varies |
ADHD CPT Therapy Codes
CPT or Current Procedural Terminology codes represent medical services like psychotherapy provided for ADHD:
Diagnostic Evaluation
Extensive developmental and medical history, diagnostic interviewing, rating scales, etc.
| Code | Description |
|---|---|
| 90791 | Psychiatric diagnostic evaluation |
Psychotherapy
Individual counseling focused on ADHD symptoms, coping strategies, compliance.
| Code | Description |
|---|---|
| 90832 | Psychotherapy, 30 minutes |
| 90834 | Psychotherapy, 45 minutes |
| 90837 | Psychotherapy, 60 minutes |
Family Therapy
Treatment provided for family members to understand ADHD dynamics.
| Code | Description |
|---|---|
| 90846 | Family psychotherapy |
| 90847 | Family psychotherapy with patient |
Group Therapy
Therapy delivered to group of patients together.
| Code | Description |
|---|---|
| 90853 | Group psychotherapy |
Neuropsych Testing
Assessment of cognitive, behavioral, emotional functioning.
| Code | Description |
|---|---|
| 96116 | Neurobehavioral status exam |
| 96121 | Neuropsych testing by psychologist |
Conclusion
ADHD coding involves using specific ICD-10 codes to represent ADHD diagnoses, CPT codes for services like therapy, and medication procedure codes for pharmacy claims. Proper coding is crucial for treatments to be covered by insurance. An ADHD diagnosis should be documented on every visit with detail on presentation, severity, comorbid conditions. Common ADHD medications also require accurate coding for reimbursement. Following coding guidelines allows for clear communication between providers, accurate records, and appropriate billing.