ADD and ADHD: Know Their Distinction
Signs and symptoms will determine the type and your code choice.
By Susan Ward, CPC, CPC-H, CPC-I, CEMC, CPCD, CPRC
I am sitting at my desk coding operative reports when the telephone rings. I answer the phone and help a patient with a billing question. When I hang up, my physician asks me a question that sends me in a completely different direction. All the while, I’m answering incoming email. Three hours go by, and it occurs to me that I have yet to finish coding those operative reports.
Is This Multitasking or ADD?
Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) affect approximately 8 million adults, and possibly 10 percent or more of all school-aged children (statistics vary widely). ADD and ADHD are related diagnoses and are often grouped together, with the distinction that ADHD includes hyperactivity.
My son (now 18) was diagnosed with ADHD at age 5. At age 3, he was like the Energizer Bunny® with an inexhaustible battery—but what 3-year-old boy isn’t? By age 4, his “fits” and impulsiveness worsened. Then, on the first day of kindergarten, I received a call from the school. The conversations (and many thereafter) were about my son not sitting still, not paying attention, and shouting out answers to questions that were completely off base.
Eventually, my husband and I decided to take our son to a developmental psychologist. Following six months of a sugar-free, caffeine-free diet and other steps, plus assessment after assessment (by physicians, teachers, and us, his parents), our child was diagnosed with ADHD.
When determining a diagnosis of ADHD, physicians are held to the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), published by the American Psychiatric Association (APA). Research shows that ADD and ADHD have nothing to do with bad parenting, family problems, bad teachers or schools, too much television, or (my favorite) too much sugar.
To substantiate ADHD, the child must have six or more signs and symptoms from one of the two categories below (or, six or more signs and symptoms from each of the two categories).
- Often fails to give close attention to details or makes careless mistakes in schoolwork and other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork or chores (not due to oppositional behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort (such as schoolwork or homework)
- Often loses things necessary for tasks or activities (for example, toys, school assignments, pencils, books)
- Often is easily distracted
- Often is forgetful in daily activities
2. Hyperactivity and Impulsivity
- Often fidgets with hands or feet or squirms in seat
- Often leaves seat in classroom or in other situations in which remaining seated is expected
- Often runs about or climbs excessively in situations in which it is inappropriate
- Often has difficulty playing or engaging in leisure activities quietly
- Often is “on the go” or often acts as if “driven by a motor”
- Often talks excessively
- Often blurts out answers before questions have been completed
- Often has difficulty taking turns
- Often interrupts or intrudes on others (for example, butts into conversations or games)
In addition to having at least six signs or symptoms from one of the two categories, a child with ADHD:
- Has inattentive or hyperactive-impulsive signs and symptoms that caused impairment and were present before age 7
- Has behaviors that aren’t normal for children the same age who don’t have ADHD
- Has symptoms for at least six months
- Has symptoms that affect school, home life, or relationships in more than one setting (such as at home and at school)
A child diagnosed with ADHD is often given a more specific diagnosis, such as:
- Predominantly inattentive-type ADHD: a child has at least six signs and symptoms from the inattention list above.
- Predominantly hyperactive-impulsive-type ADHD: a child has at least six signs and symptoms from the hyperactivity and impulsivity list above.
- Combined type ADHD: a child has six or more signs and symptoms from each of the two lists above.
When assigning ICD-9-CM codes, report 314.00 Attention deficit disorder without mention of hyperactivity for ADD and 314.01 Attention deficit disorder with hyperactivity for ADHD.
As we move forward to ICD-10-CM, the coding is reflective of the specificity that the APA has required.
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
As a coder, the good news is the specificity of ICD-10 is coming. As the mother of a child with ADHD, the good news is that research shows approximately 93 percent of children diagnosed with ADD or ADHD can acquire coping skills to adjust without the use of medications in adulthood.
Susan Ward, CPC, CPC-H, CPC-I, CEMC, CPCD, CPRC, has 20 years of coding and billing experience. She is coding and billing manager for Travis C. Holcombe, MD, an AAPC workshop presenter and AAPC ICD-10 trainer, and is the 2012 president of the West Valley Glendale chapter. She’s held offices with the Phoenix chapter, and is a member of the 2012-2013 AAPCCA Board of Directors, Region 8 – West. Susan served on the AAPC National Advisory Board from 2007-2009.