Neurology & Pain Management Coding Alert

Know what behaviors characterize the disorder.

Read carefully what history your neurologist obtained and how the diagnosis was arrived.

ADHD is a chronic condition with three subtypes of behaviors: 1) hyperactive-impulsive, 2) inattentive (formerly known as Attention Deficit Disorder [ADD]) and 3) hyperactive-impulsive and inattentive combined. It is usually first diagnosed in childhood and often persists into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active. Any of the primary symptoms may predominate, though the combined type, with both inattentive and hyperactivity/impulsive symptoms, is the most common type of ADHD. The neurologist’s documentation of the patient’s history should support the diagnosis of ADHD. Documentation might include findings such as:

The child has difficulty maintaining attention and performs poorly in school.

Parents or teachers may complain that the child is restless, rebellious, and undisciplined.

The child may be reported as an underperformer in activities that needed a focused mental effort. The child might exhibit difficulty following instructions, make careless mistakes, not complete homework, and have trouble organizing tasks.

The child may show compulsive talking and frequently may leave his or her school desk to wander around.

You also should be watchful if your neurologist revised the medication for an established patient of ADHD. The neurologist may try to assess the extent of symptom control to be able to revise a prescription. A physical examination, mental status examination, and assessment for learning disabilities may also be required. The physician also may conduct interviews with the child's parents and send out standardized behavior rating scales or questionnaires to be filled in by his or her teachers at school. These findings will help you to determine the right E/M code.