August 2, 2010

Coding for ADHD/ADD
For The Record
Vol. 22 No. 14 P. 27

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition characterized by a pattern of inattention, hyperactivity, and impulsive behaviors. It’s common in children and often persists into adulthood. Some patients may be diagnosed with attention-deficit disorder (ADD), which is the same as ADHD but lacks the hyperactivity component. The cause of ADHD/ADD is unknown, but it is considered a neurobiological disorder. The chances of developing ADHD/ADD increase if someone’s mother smoked or used drugs or alcohol during pregnancy or if a relative has the disorder.

Symptoms
The following are two groups of symptoms commonly associated with those diagnosed with ADHD/ADD:

Inattention
• fails to pay close attention to details or makes careless mistakes in schoolwork and other activities;

• has difficulty staying focused;

• has poor listening skills;

• does not follow instructions accurately and completely;

• cannot finish tasks;

• has difficulty organizing tasks and activities;

• loses or forgets items such as school books and assignments;

• is easily distracted by things happening around him or her; and

• forgets to complete daily activities.

Hyperactivity and Impulsivity
• fidgets with hands or feet;

• has trouble sitting still for very long;

• frequently runs or climbs;

• has difficulty playing or working quietly;

• is constantly moving;

• talks excessively;

• frequently blurts out answers before a question is finished;

• has difficulty waiting to take a turn; and

• interrupts others.

Diagnosis
To diagnose ADHD, a child must have six or more symptoms from one of the two categories noted above. Additionally, a child with ADHD will also meet the following requirements:

• The symptoms caused problems before the age of 7.

• The behavior is abnormal for children who are the same age and do not have ADHD.

• The symptoms last longer than six months.

• The symptoms impair school interactions and work, home life, or relationships in more than one setting.

Psychiatrists, psychologists, pediatricians, family physicians, and neurologists are trained to diagnose and treat ADHD.

Types of ADHD
The three types of ADHD are as follows:

• Predominantly inattentive type ADHD: The patient has at least six symptoms from the “inattention” category previously mentioned.

• Predominantly hyperactive-impulsive type ADHD: The patient has at least six symptoms from the hyperactivity and impulsivity category previously mentioned.

• Combined type ADHD: The patient has six or more symptoms from each of the two categories.

ICD-9-CM Code Classification
ADD is classified to ICD-9-CM code 314.00, which includes predominantly inattentive type or undifferentiated ADD. Code 314.00 also includes unspecified ADD. Assign code 314.01 for ADHD or hyperactivity associated with ADD. Code 314.01 includes the predominantly hyperactive-impulsive type, the combined hyperactive and inattentive type, and overactivity, not otherwise specified. If ADD is specified as a residual type, assign code 314.8, Manifestation of hyperkinetic syndrome.

The same ICD-9-CM codes apply whether the condition is diagnosed in a child or in an adult, and the symptoms are much the same in adults as they are in children. Although the hyperactivity may no longer occur in the case of an adult, the symptoms of inattention and impulsiveness are still present. ADD in adults is diagnosed based on reports from the patient and the people who are close to him or her, such as family, friends, or coworkers.

Treatment
ADHD/ADD is mainly treated with medications, commonly the following psychostimulants:

• methylphenidate (Ritalin, Concerta, Daytrana);

• dextroamphetamine-amphetamine (Adderall); and

• dextroamphetamine (Dexedrine).

The use of psychostimulants is short term and must be frequently monitored.

Coding and sequencing for ADHD/ADD are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CMand American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.