Neurology & Pain Management Coding Alert

Question: Our payer is denying any claims our pediatric neurologists submit for patients with ADHD if we include a diagnosis from the 290-319 series. Are there any alternative diagnoses? Ohio Subscriber Answer: The correct diagnosis for ADHD is 314.01 (Attention deficit disorder; with hyperactivity). If the payer denies your claims with this diagnosis, it might be because your physician is not a mental-health provider. Check to see if the patient has a separate address or carrier for mental-health claims; if so, submit your claim to that payer. V code question: Some coders say that if your physician follows up on medication to treat the patient's ADHD, your claim should include a V code with the ADHD diagnosis. You only use a V code, however, when no other ICD-9 code fits the situation. You shouldn't report a V code in your case because of 314.01.