How to Choose the Right ICD-10 Code for ADHD

Even after all these years of having ICD-10 in place, the work of finding the right code to match your diagnosis can be tricky. We’re here to help you find the correct ICD-10 code for ADHD—a diagnosis you might not be using as regularly in your work with patients. 

What is attention-deficit/hyperactivity disorder (ADHD)? 

ADHD might not be something that you studied in school—but that doesn’t mean you won’t encounter it in your practice. For example, those who work with pediatric patients may encounter neurodevelopmental disorders. 

In some instances, you may find patients struggling to pay attention to what you’re saying or are unable to sit still.  Others might struggle with self-control or impulsivity. All of these examples suggest a possibility of ADHD.

The National Institute of Mental Health states that a possible ADHD patient shows some of these behaviors: 

• Inattention, which is defined as the inability to stay focused, organized, or on task;
• Hyperactivity, which is defined as constant movement or talking, including in situations where it isn’t appropriate, and
• Impulsivity, which is defined as a difficulty in exercising self-control or the tendency to act without thinking.   

If you’re dealing with a patient who may have ADHD, you should also be on the lookout for signs of oppositional defiant disorder (ODD)—a condition that commonly occurs with ADHD. The CDC outlines the symptoms of ODD as: 

• Frequent loss of temper;
• Consistent arguing with adults or refusal to comply with instructions;
• Anger, resentment, or desire to hurt someone who caused them pain;
• Intentionally annoying others, or becoming easily annoyed by others; and   
• Blaming others for their behavior.

What are the ICD-10 Codes for ADHD?

If you think that an ADHD diagnosis is appropriate for a patient, you can select from an ICD 10 diagnosis code for ADHD. Here are the specific codes for ADHD:    

• 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

What are the exclusions (Excludes2) for ADHD ICD-10 codes?

As with other diagnoses commonly seen in your practice, a patient with ADHD may have other conditions that, while not reflected in the ICD-10 code for ADHD, are present in the patient. In that instance, you may need to rely on Excludes2 to use both codes together.  

For the F90 series of ICD-10 codes for ADHD here are the special exclusions listed in the ICD-10-CM:

• Anxiety disorders (F40.-, F41.-)
• Mood (affective disorders) (F30-F39)
• Pervasive developmental disorders (F84.-)
• Schizophrenia (F20.-)

How can I better help patients with ADHD? 

Rehab therapists can play a part in helping pediatric patients with ADHD. For a start, there’s evidence that deficiencies in fine motor skills are often tied to ADHD — and who better to help with that issue than movement experts? Another study, “Effectiveness of Physical Activity Intervention on ADHD Symptoms: A Systematic Review and Meta-Analysis,” found that physical activity intervention could prove effective in improving ADHD symptoms in young patients, meaning that the treatment you’re providing could play a role in alleviating some of these issues as well. 

Occupational therapists, in particular, can play a big role in helping patients with ADHD. As  Elisabeth Bahr, OTD, MS, OT/L writes in the blog “Supporting Children with ADHD through Occupational Therapy”, OTPs can help create a more accommodating learning environment through environmental modifications, visual supports, behavior management techniques, and personalized modifications. Bahr also stresses that multimodal treatment is necessary for ADHD, and often includes one or more of the following:

• Medication
• Parent training
• Skill-specific training
• Mental health treatment
• Behavioral therapy
• Classroom interventions

If you’re not a trained OT, treating patients with ADHD might take some adjustment to engage with them in their care effectively. This blog from Snyder Physical Therapy addresses some techniques PTs might suggest to parents of ADHD patients, such as: 

• Using positive reinforcement to encourage desired behaviors;   
• Emphasizing better sleep habits;
• Creating daily routines; and
• Establishing a better diet. 

Does applied behavioral analysis (ABA) therapy make sense for ADHD? 

Finding the right ICD-10 code for ADHD is a great start—but what about finding additional help for patients and their parents who might not have been previously aware of a possible ADHD diagnosis? 

If you have a referral relationship, you should consider sending possible ADHD patients to an ABA clinic. ABA is often associated with patients with autism, but it can also help patients with other developmental disorders. As this blog from Award Behavioral Health outlines, there are a few ABA techniques commonly used with ADHD patients:

• Differential reinforcement of behaviors, where positive reinforcement is offered along with a lock of negative reinforcement;
• Discrete trial training and task analysis, where complex negative behaviors are broken down into smaller parts, and those smaller parts are emphasized to reinforce positive behaviors; 
• Self-management training, where older children learn self-awareness and ABA techniques to manage their behavior; and     
• Pivotal response training, which is a play-based technique with neutral motivational strategies related to the child’s specific behavior. 

When should I use the ICD-10 code for ADHD?

As a group of philosophers once said, “Knowing is half the battle.” Now that you know which ICD-10 code for ADHD applies to which condition, as well as some of the other behaviors you might see related to ADHD, you’re probably wondering when the right time to use those codes is. As our resident coding expert John Wallace, PT, MS, OCS, would say, code to the greatest level of specificity; in this case, if you’re looking at the F90 codes, only code F90.9 if you are truly unable to determine a more specific ADHD diagnosis.   

Well, there you have it—the basics of finding the right ICD-10 code for ADHD. If you want more tips on coding best practices and how to select the right ICD-10 code, check out our ICD-10 guide, and be sure to stay tuned to the WebPT blog for the latest industry news and information.