ADHD coding project

ADHD Coding Project
Dana L. Anderson
Heritage College
Medical Billing & Coding Associate’s Degree 2015-2016

Description of Attention-deficit/Hyperactivity
Disorder (ADHD)
 Attention deficit hyperactivity disorder (ADHD) is one of the most common developmental
disorders (Spencer et al 2007).
 It is estimated to affect 5%–10% of the child population (Faraone et al 2003) and from 1%–6% of
the adult population (Kessler et al 2005).
 In a recent large epidemiological study in the United States, 4.4% of the adult population was
determined to have clinically significant ADHD symptoms (Kessler et al 2006)
 ADHD is, therefore, a very prevalent disorder across the developmental spectrum
 ADHD is a chronic neurobiological disorder which affects the brain structurally and chemically, as
well as the ways in which various parts of the brain communicate with one another. It is highly
heritable.
 Attention deficit hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder that begins in
childhood and is characterized by some combination of hyperactivity, impulsivity, and/or
inattention.
Continued…

Description of Attention-Deficit/Hyperactivity
Disorder (ADHD)
 ADHD is divided into three different types:
 Predominantly Inattentive Type
 A person with this type must have at least six of these nine symptoms, and very few of the symptoms of
hyperactive-impulsive type
 Predominantly Hyperactive-impulsive Type
 To have this type, a person has to have at least six of these nine symptoms, and very few of the symptoms of
inattentive type
 Combination Type
 This is the most common type of ADHD. People with it have symptoms of both inattentive and hyperactive-impulsive
types.
 inattention: getting distracted easily, having poor concentration and organizational skills
 impulsivity: interrupting, taking risks
 hyperactivity: never seeming to slow down, constantly talking and fidgeting, difficulty staying on task

ICD-9 Codes for Attention-deficit/hyperactivity
disorder (ADHD)
Description ICD-9CM code
Attention deficit disorder 314.0
Without mention of hyperactivity Predominantly
inattentive type 314.00
With hyperactivity Combined type Over- activity
NOS Predominantly hyperactive/impulsive type
Simple disturbance of attention with over-activity 314.01

ICD-10 Codes for Attention-
Deficit/Hyperactivity Disorder (ADHD)
Description ICD-10CM code
Attention-deficit hyperactivity disorder,
predominantly inattentive type F90.0
predominantly hyperactive type F90.1
Attention-deficit hyperactivity disorder, combined
type F90.2
Attention-deficit hyperactivity disorder, other type F90.8
unspecified type F90.9

DSM IV Codes for Attention-
Description DSM V
Combined Type 314.01
Predominantly Hyperactive-Impulsive Type 314.01
Predominantly Inattentive Type 314.00
Unspecified Attention-Deficit/Hyperactivity
Disorder
314.01
*Specify current severity: Mild ,Moderate, Severe
*Specify if: In partial remission
Specific learning disorder
With impairment in reading 315.00
With impairment in written
expression
315.2
With impairment in mathematics 315.1
*Specify current severity:
Mild ,Moderate, Severe

Comorbid Conditions for Attention-
Psychiatric ICD-10-CM Exclusions
Oppositional Defiant Disorder
(ODD) F91.3
Major Depression F32.0-F32.9
Dysthymia F43.1
Anxiety F41.0-F41.9
Bipolar Disorder (BD) F31.0-F31.9
Post Traumatic Stress Disorder
(PTSD) F43.10-F43.12
Borderline Personality Disorder F60.3
Conduct Disorder (CD) F91.0-F91.9 EXCLUDES F91.3
Antisocial Personality Disorder F60.2
Suicidal Ideations R45.89
Continued…

Psychiatric ICD-10-CM Exclusions
Obsessive-Compulsive Disorder
F42
Sensory Integration Disorder F88
Learning Disorders F81.0-F81.9
Early Speech/Communication
problems F80.9
Substance Abuse F10-F19
Pervasive Developmental
Disorder (PDD) F84.9
Anger-Control Problems R45.4
Tic Disorder F95.0-F95.9
Tics and Tourette’s Disorder (TD) F95.0-F95.9
EXCLUDES F95.2
Developmental Dyslexia F81.0-F81.9
Self harm X78.- A,D,S Continued…

Physical ICD-10-CM Specificity
Enuresis F98.0-F98.1
R32
Enuresis G40.9-
Very generalized term, mostly in
adults
Developmental Coordination
Disorder (Clumsy) F82
Fibromyalgia M79.1
Legg-Calvé-Perthes Disease M91.- Depending on laterality
Hypertension R45.4
Height and Weight Problems Due to Treatment
Eczema L30.9
Allergies rhinitis NOS J30.9
Continued…

Physical ICD-10-CM Exclusions
Sleep Problems such as:
sleep disordered breathing R06.3
Restless Legs Syndrome (RLS) G25.8
obstructive sleep apnea (OSA) G47.33
Delayed Sleep Phase Disorder G47.21
periodic limb movement disorder
(PLMD) G47.61

Symptoms of Attention-Deficit/Hyperactivity
Disorder (ADHD) in Children
Symptoms of Children Example
Often makes careless mistakes and lacks attention
to details
overlooking or missing details or handing in work that’s
inaccurate
Often has difficulty paying attention to tasks or
while playing
difficulty remaining focused during class, conversations, or
lengthy readings
Often seems to not listen when spoken to directly
mind seems elsewhere, even in the absence of obvious
distraction
Often fails to follow through on instructions,
schoolwork, or chores
starts tasks but quickly loses focus and is easily
sidetracked
Often has difficulty organizing tasks and activities
Examples: messy, disorganized work; poor time
management
Often avoids, dislikes, or is reluctant to participate
in tasks requiring sustained mental effort, like
schoolwork or homework
Often loses things like school materials or, if older,
wallets, keys, eyeglasses, and mobile phones
Often easily distracted
Continued…

Symptoms of Attention-Deficit/Hyperactivity
Disorder (ADHD) in Children
Symptoms of Hyperactivity and
Impulsivity in Children Example
Often fidgets with or taps hands and feet or squirms
in seat
Often leaves seat when remaining seated is
expected
leaves their place in the classroom or in other situations
that require remaining seated
Often runs or climbs where it is inappropriate or
feels restless
Often acts as if "on the go" or “driven by a motor”
is unable or uncomfortable being still for an extended
time, as in restaurants
Often talks excessively Often blurts out an answer before a question has been
fully asked
Often has difficulty waiting his or her turn while waiting in line
Often interrupts or intrudes on others
butts into conversations, games, or activities; may start
using other people’s things without asking or receiving
permission

Symptoms of Attention-deficit/hyperactivity
disorder (ADHD) in Adults
Symptoms of Adults Example
Often makes careless mistakes and lacks attention to
details
overlooking or missing details or handing in work that is
inaccurate
Often has difficulty paying attention to tasks
difficulty remaining focused during lectures,
conversations, or lengthy reading
Often seems to not listen when spoken to directly
mind seems elsewhere, even in the absence of obvious
distraction
Often fails to follow through on instructions, chores, or
duties in the workplace
starts tasks but quickly loses focus and is easily
sidetracked
Often has difficulty organizing tasks and activities
messy, disorganized work; poor time management; fails to
meet deadlines
Often avoids, dislikes, or is reluctant to participate in tasks
requiring sustained mental effort, like preparing reports,
completing forms, or reviewing lengthy papers
Often loses things like tools, wallets, keys, paperwork,
eyeglasses, and mobile phones
Often easily distracted by other things, including
unrelated thoughts
Often forgetful in daily activities, such as running errands,
returning calls, paying bills, and keeping appointments
Continued…

Symptoms of Attention-deficit/hyperactivity
disorder (ADHD) in Adults
Symptoms of Hyperactivity and
Impulsivity in Adults Example
Often fidgets with or taps hands and feet or squirms in
seat
Often leaves seat when remaining seated is expected
leaves their place in the office or other workplace setting
or in other situations that require remaining seated
Often runs or climbs where it is inappropriate or feels
restless (in adults, may be limited to feeling restless)
Often unable to participate in leisure activities quietly
Often acts as if “on the go" or “driven by a motor”
is unable to be or uncomfortable being still for an
extended time, as in meetings or restaurants
Often talks excessively
Often blurts out an answer before a question has been fully
asked
completes people’s sentences; cannot wait for next turn in
conversation
Often has difficulty waiting his or her turn, for example,
while waiting in line
Often interrupts or intrudes on others
butts into conversations, games, or activities; may start
using other people’s things without asking or receiving
permission; may intrude into or take over what others are
doing

Causes of Attention-Deficit/Hyperactivity
Disorder (ADHD)
 Genetic
 No one knows for sure. ADHD probably stems from interactions between genes and
environmental or non-genetic factors.
 Researchers have found that much of the risk of having ADHD has to do with genes.
 If a parent has ADHD, a child has more than a 50% chance of having it. If an older sibling has it, a child
has more than a 30% chance.
 ADHD is very complex and a genetic test for diagnosing the disorder is not yet available.
 Some studies suggest that artificial food additives and dyes may worsen hyperactivity and
inattention, but these effects are small and do not account for most cases of ADHD.
 May have an imbalance in the level of neurotransmitters in the brain, or that these chemicals
may not work properly. (Dopamine)
Continued…

Causes of Attention-Deficit/Hyperactivity
Disorder (ADHD)
 Non-Genetic
 Non-genetic factors that may increase a child’s risk for developing ADHD
 Smoking or drinking during pregnancy
 Birth complications or very low birth weight
 Exposure to lead or other toxic substances
 Extreme neglect, abuse, or social deprivation
 Food additives like artificial coloring, which might make hyperactivity worse
 lack of harmony between parents and in family life
 hostile relationships between parents and children
 difficulties between siblings
 lower socio-economic status
 mental health problems
 criminal behavior
 There are certain aspects of the family environment that are found more often in children with ADHD.
 Head injuries to the frontal lobe of the brain, the area that controls impulses and emotions
 Epilepsy

Treatment in Children for Attention-
deficit/hyperactivity disorder (ADHD)
Therapy Definition
Cognitive Behavior Therapy (CBT)
Also known as behavior modification, has been shown to be
a very successful treatment for children with ADD / ADHD. It
is especially beneficial as a co-treatment for children who
take stimulant medications and may even allow you to
reduce the dosage of the medication.
Social skills training
Because kids with attention deficit disorder often have
difficulty with simple social interactions and struggle with
low self-esteem, another type of treatment that can help is
social skills training. Normally conducted in a group setting,
social skills training is led by a therapist who demonstrates
appropriate behaviors and then has the children practice
repeating them.
Parent Training
Helped parents learn about ADHD and ways to manage
ADHD behaviors. This approach included techniques by
which the parents can have positive interactions with their
child while becoming more effective at getting their
children to meet expectations for behavior
School-Based Interventions
Helped teachers meet children’s educational needs by
helping them to learn the skills to manage children’s ADHD
behaviors in the classroom (such as rewards, consequences,
classroom seating, and daily report cards sent to parents)
Continued…

Other Ways to Manage ADHD Definition
Keeping a routine and a schedule
Keep the same routine every day, from wake-up time to
bedtime. Include times for homework, outdoor play, and
indoor activities. Keep the schedule on the refrigerator or
on a bulletin board in the kitchen. Write changes on the
schedule as far in advance as possible.
Organizing everyday items
Have a place for everything, and keep everything in its
place. This includes clothing, backpacks, and toys. Use
organizers for school material and supplies. Stress to your
child the importance of writing down assignments and
bringing home the necessary books.
Being clear and consistent
Children with ADHD need consistent rules they can
understand and follow.
Giving praise or rewards when rules are
followed
Children with ADHD often receive and expect criticism.
Look for good behavior, and praise it.
Neurofeedback
a computer-aided training method in which selected
parameters of the patient´s own brain activity, which can
normally not be perceived, are made visible to the patient.
Via monitor and loudspeaker the brain is shown what it is
doing at the moment
Continued…

Medication
Stimulants
• Amphetamines
• Adderall and XR (Dextroamphetamine)
• Dexedrine (dextroamphetamine)
• Vyvanse (Lisdexamfetamine)
• Dexedrine Spansule (dextroamphetamine)
• Methylphenidate
• Concerta (Methylphenidate)
• Daytrana (methylphenidate)
• Focalin and XR (Dexmethylphenidate)
• Metadate ER and CD (extended release methylphenidate)
• Methylin (methylphenidate hydrochloride)
• Ritalin and LA or SR (Methylphenidate)
• Quillivant XR (Methylphenidate)
Non-Stimulants
• Norepinephrine Uptake Inhibitor • Strattera (Atomoxetine)
• Alpha Adrenergic Agent
• Intuniv (guanfacine)
• Kapvay (Clonidine)
Antidepressants
• Wellbutrin (Buproprion Hydrochloride)
• Tofranil (Imipramine)
• Pamelor (Nortriptyline)
• Lexapro (Escitalopram)
Continued…

Medication
Stimulants
• Amphetamines
• Methylphenidate
• Daytrana (methylphenidate)
Non-Stimulants
Antidepressants
• Wellbutrin (Buproprion Hydrochloride)

Treatment in Adults for Attention-
Therapy
Psychotherapy (also called talk therapy,
therapy, or counseling)
a process focused on helping you heal and learn more
constructive ways to deal with the problems or issues
within your life
Cognitive Behavior Therapy
a type of psychotherapy in which negative patterns of
thought about the self and the world are challenged in
order to alter unwanted behavior patterns or treat mood
disorders such as depression
Relaxation training and stress management Relaxation training and stress management
Life coaching
It may help you set goals. Plus, it can help you learn new
ways to stay organized at home and work.
Job coaching or mentoring
This can help support you at work. It can help you have
better working relationships and improve on-the-job
performance.
Family education and therapy
This can help you and loved ones understand ADHD better.
It can also help you all find ways to lessen how much it
affects everyone’s life.
Neurofeedback
a computer-aided training method in which selected
parameters of the patient´s own brain activity, which can
normally not be perceived, are made visible to the patient.
Via monitor and loudspeaker the brain is shown what it is
doing at the moment Continued…

Other Ways to Manage ADHD
Organize
Breathe slowly
Cut down on distractions
Burn off extra energy (Exercise)
Diet
• Add more omega-3 fatty acids to your diet
• Schedule regular meals or snacks no more than three hours
apart
• Make sure you’re getting enough zinc, iron, and magnesium in
your diet
• Try to include a little protein and complex carbohydrates at
each meal or snack
• Add more omega-3 fatty acids to your diet
Meditation
Yoga
Continued…

Medication
Stimulants
• Amphetamines
• Methylphenidate
• Daytrana (methylphenidate )
Eugeroic (wakefulness-promoting agent) • Provigil (Modafinil)
Nonstimulants
Antidepressants
• Wellbutrin SR and XL (Buproprion Hydrochloride)
• Norpramin (Desipramine HCL)

Documentation of Attention-
Documentation
Personal demographics
• Name
• Nickname or
aliases
• Age/ Date of
Birth
• Address
• Phone
• Email
• Gender
• Sexual Orientation
• Relationship status
• Religious
preference (if any)
• Ethnicity
Primary Care Physician
• Address
• Phone
• Last Physical
Exam
Family history • Mental Disorders
Documentation
Personal History
• Last Psych
Diagnosis,
treatment plan (if
previously treated)
• Use of drugs
• Types,
• How long
• How much
• Use of Alcohol
• How much
• Smoker
• How much
• Surgeries • Allergies
• Vitals
• Weight
• Height
• BP
Continued…

Documentation
Psychiatric Testing
• Screen for mental
illnesses
• Documentation of
underlying
emotional issues
• Social worker
documentation
• (See also
SYMPTOMS Tab)
Medication records
• General records
from PCP
Documentation
Treatment plan • Therapy
• Weekly
• Bi-weekly
• As Needed
• Medicatio
ns
• Type
• Dose
• When to
take
• Side
Effects
• Follow up
plan
• 1 month
• 3 months
• 6 months
Continued…

Documentation
Physician visits
• Regular physician visits to safeguard
physical health
• Documentation of symptoms such as
mood disorders, anxiety disorders and
personality disorders
• Suicide ideation
• Substance abuse
Documentation
Diagnosis
Attention-
deficit/hyperact
ivity disorder
(ADHD) Type:
o Predominantly
Inattentive Type
o Predominantly
Hyperactive-impulsive
Type
o Combination Type
Comorbid conditions
Labs
• (depending on
medications)
• Blood
• Liver
• Cardio

Resources for this project on Attention-
Symptoms  http://www.vyvanse.com/adhd-adult-symptoms
Causes
 http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-easy-to-
read/index.shtml#pub4
 http://www.webmd.com/add-adhd/guide/adhd-causes
 http://psychcentral.com/lib/causes-of-attention-deficit-disorder-adhd/
 http://www.netdoctor.co.uk/conditions/adhd/a5225/what-causes-adhd/
 https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/add-
adhd/possible-causes-of-adhd-attention-deficit-hyperactivity-disorder?view=slideview
Continued...

Description
 https://www.medicalhomeportal.org/diagnoses-and-conditions/attention-deficit-hyperactivity-
disorder
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518387/
 http://qz.com/592364/decades-of-failing-to-recognize-adhd-in-girls-has-created-a-lost-generation-of-
women/
Codes  http://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F90-/F90.0
 http://psychcentral.com/disorders/dsm-iv-diagnostic-codes/#adhd
 www.medicalhomeportal.org/diagnoses-and-conditions/attention-deficit-hyperactivity-disorder
 DSM V Page 59-65
Continued...

Comorbidity  www.mentalhelp.net/articles/adhd-comorbidity
Treatment
• ADULT  www.webmd.com/add-adhd/adhd-adults?page=3#2
 www.helpguide.org/articles/add-adhd/adult-adhd-attention-deficit-disorder-treatment.htm
 http://psychcentral.com/lib/treatment-for-adhd/
 www.chadd.org/Understanding-ADHD/For-Adults/Treatment/Medication-Management.aspx
• CHILDREN  www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-treatment-in-children.htm
 www.webmd.com/add-adhd/childhood-adhd/adhd-children?page=2#2
 file:///C:/Users/danal/Downloads/adhd-parents-medication-guide.pdf
 www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Thank you!
All information was gathered and researched by a non clinical student, some
information may be left out, or incorrect due to advances in medical science, and
mental health information.
Dana L. Anderson

ADHD coding project

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