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July 23, 2007

Coding for Learning Disabilities
For The Record
Vol. 19 No. 15 P. 43

Learning disabilities are defined as “inabilities to acquire, retain, or broadly use specific skills or information, resulting from deficiencies in attention, memory, or reasoning and affecting academic performance.”1 Children with learning disabilities have trouble coordinating vision with movement and may be delayed in learning to read and write. In addition, they may have difficulty with communicating and controlling impulses. Other common symptoms include a short attention span, being easily distracted, a short memory span, hyperactivity, and being withdrawn, shy, or aggressive.

The ICD-9-CM code assignment for learning disability not further specified is 315.2.

Dyslexia is a language-based disability caused by a brain impairment when interpreting images into meaningful language. Children with dyslexia, who usually have normal eyesight and average or above intelligence, have difficulty interpreting spoken language and writing. The common symptoms of dyslexia include the inability to recognize words and letters on a printed page, a reading ability level below the expected level for the child’s age, difficulty processing and understanding what is heard, and trouble understanding written words.

Although dyslexia cannot be cured, it is treated with multisensory teaching methods. Developmental dyslexia is classified to code 315.02 and dyslexia secondary to organic lesion to code 784.61. Code 784.61 is also assigned for unspecified dyslexia.

Dyscalculia (code 315.1) is a mathematical disability in which a person has difficulty solving arithmetic problems and grasping mathematical concepts. Some common symptoms include difficulty with abstract concepts of time and direction; the mistaken recollection of names; inconsistent results in addition, subtraction, multiplication, and division; poor mental math ability; an inability to grasp and remember math concepts, rules, and formulas; and difficulty keeping score during games.

People with dyscalculia have normal or accelerated verbal, reading, and writing skills with good visual memory of printed words.

Dysgraphia (or agraphia, code 784.69) is a writing disability in which a person has difficulty forming letters or writing in a defined space. Symptoms include poor writing skills but strong verbal skills, random punctuation, generally illegible writing, mixtures of print and cursive, unfinished words or letters, and inconsistent spaces between words and letters.

Dyspraxia (or apraxia, code 784.69) is difficulty planning and completing fine motor tasks. Children with dyspraxia may have difficulty using utensils, brushing their teeth, and working with buttons and zippers. If dyspraxia syndrome is documented, assign code 315.4.

Attention deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD) is characterized by a persistent pattern of poor or short attention span and inappropriate impulsiveness. To diagnose ADD/ADHD, patients must exhibit at least six of the following symptoms in either group for at least six months to a disruptive and inappropriate level for the developmental stage:

Group A:

1. Often fails to give close attention to details or makes careless mistakes

2. Often has difficulty sustaining attention

3. Often does not seem to listen when spoken to directly

4. Often does not follow through on instructions and fails to finish duties

5. Often has difficulty organizing tasks and activities

6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort

7. Often loses things necessary for tasks or activities

8. Often easily distracted by extraneous stimuli

9. Often forgetful in daily activities

Group B:

1. Often fidgets with hands or feet or squirms in seat

2. Difficulty with remaining seated when required

3. Often runs about or climbs excessively in inappropriate situations

4. Often has difficulty playing or engaging in quiet leisure activities

5. Often “on the go”

6. Talks excessively

7. Blurts out answers before questions have been completed

8. Difficulty in waiting for turn in games or group situations

9. Often interrupts or intrudes on others

ADD/ADHD may be treated with a combination of behavior therapy and psychostimulant drugs. ADD is classified to code 314.00 and ADHD to code 314.01.

Coding and sequencing for learning disabilities 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-CM and 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 nearly 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.