Wiki ADD & AD/HD Proper coding

[SBennett48]

I code for several Pediatricians that keep using 799.51 primary to 314.01 & 314.00. If the patient has a definitive diagnosis of ADD or AD/HD you should code 314.00 or 314.01 primary and you don't need 799.51 after it because you wouldn't code the symptoms if you have a definitive diagnosis, correct? Of what I have read, once the individual has been diagnosed with ADD or ADHD; this is considered a chronic condition that is treated with closely monitored medications and guidance.

They state the reason they use 799.51 is because the ADD and ADHD codes are 'Psych Codes' and you can't use them as primary. They also stated that they lose money if they use 314.00 or 314.01 as primary. I have researched many claims with 799.51 & 314.00 or 314.01 as primary and alot of times the 799.51 doesn't get paid at all. The 314.00 or 314.01 is paying the same amount as the 799.51.

Does anyone have any other concrete evidence/guidelines that I can share with my Pediatricians?

Thanks,

Shannon

 

[mitchellde]

If the patient has not been diagnosed with ADD or ADHD then the 799.51 is a good choice. However once testing results are evaluated and the diagnosis is given as ADD or aDHD then the 799.51 code does go away. So I guess the real question is whether the patient actually been tested for and subsequently diagnosed with the condition. You would be surprised at how many are not!

 

[SBennett48]

Add/adhd

Thank you for your reply. I do make sure in the documentation that the child has been tested and they are either ADD or ADHD. If they have not been tested then I use the 799.51 because they only have symptoms at this point. I am meeting with my Pediatricians next week to show them that using the symptom code when the child has been tested and diagnosed is incorrect and won't get paid properly, if at all. They need to be using the definitive dx when the child has been diagnosed and drop the 799.51 to be properly paid, along with proper coding. Some physicians think that just because they have done it a certain way for years that it is the right way. Most physicians aren't coders so they don't keep up on current rules and guidelines.