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ADHD Coding Project
Dana L. AndersonHeritage College
Medical Billing & Coding Associate’s Degree 2015-2016
Description of Attention-deficit/Hyperactivity Disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) is one of the most common
developmental disorders (Spencer et al 2007). It is estimated to affect 5%–10% of the child population (Faraone et al 2003)
and from 1%–6% of the adult population (Kessler et al 2005). In a recent large epidemiological study in the United States, 4.4% of the adult
population was determined to have clinically significant ADHD symptoms (Kessler et al 2006)
ADHD is, therefore, a very prevalent disorder across the developmental spectrum
ADHD is a chronic neurobiological disorder which affects the brain structurally and chemically, as well as the ways in which various parts of the brain communicate with one another. It is highly heritable.
Attention deficit hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder that begins in childhood and is characterized by some combination of hyperactivity, impulsivity, and/or inattention.
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Description of Attention-Deficit/Hyperactivity Disorder (ADHD) ADHD is divided into three different types:
Predominantly Inattentive Type A person with this type must have at least six of these nine symptoms, and very few of the
symptoms of hyperactive-impulsive type Predominantly Hyperactive-impulsive Type
To have this type, a person has to have at least six of these nine symptoms, and very few of the symptoms of inattentive type
Combination Type This is the most common type of ADHD. People with it have symptoms of both inattentive and
hyperactive-impulsive types. inattention: getting distracted easily, having poor concentration and organizational skills impulsivity: interrupting, taking risks hyperactivity: never seeming to slow down, constantly talking and fidgeting, difficulty staying
on task
ICD-9 Codes for Attention-deficit/hyperactivity disorder (ADHD)
Description ICD-9CM codeAttention deficit disorder 314.0Without mention of hyperactivity Predominantly inattentive type 314.00With hyperactivity Combined type Over- activity NOS Predominantly hyperactive/impulsive type Simple disturbance of attention with over-activity 314.01
ICD-10 Codes for Attention-Deficit/Hyperactivity Disorder (ADHD)
Description ICD-10CM codeAttention-deficit hyperactivity disorder, predominantly inattentive type F90.0Attention-deficit hyperactivity disorder, predominantly hyperactive type F90.1Attention-deficit hyperactivity disorder, combined type F90.2Attention-deficit hyperactivity disorder, other type F90.8Attention-deficit hyperactivity disorder, unspecified type F90.9
DSM IV Codes for Attention-Deficit/Hyperactivity Disorder (ADHD)
Description DSM VCombined Type 314.01Predominantly Hyperactive-Impulsive Type 314.01
Predominantly Inattentive Type 314.00Unspecified Attention-Deficit/Hyperactivity Disorder
314.01
*Specify current severity: Mild ,Moderate, Severe
*Specify if: In partial remission
Specific learning disorderWith impairment in reading 315.00With impairment in written expression 315.2With impairment in mathematics 315.1
*Specify current severity:
Mild ,Moderate, Severe
Comorbid Conditions for Attention-Deficit/Hyperactivity Disorder (ADHD)
Psychiatric ICD-10-CM ExclusionsOppositional Defiant Disorder (ODD) F91.3Major Depression F32.0-F32.9Dysthymia F43.1Anxiety F41.0-F41.9Bipolar Disorder (BD) F31.0-F31.9Post Traumatic Stress Disorder (PTSD) F43.10-F43.12Borderline Personality Disorder F60.3Conduct Disorder (CD) F91.0-F91.9 EXCLUDES F91.3Antisocial Personality Disorder F60.2Suicidal Ideations R45.89 Continued…
Comorbid Conditions for Attention-Deficit/Hyperactivity Disorder (ADHD)
Psychiatric ICD-10-CM ExclusionsObsessive-Compulsive Disorder
F42
Sensory Integration Disorder F88Learning Disorders F81.0-F81.9Early Speech/Communication problems F80.9Substance Abuse F10-F19Pervasive Developmental Disorder (PDD) F84.9Anger-Control Problems R45.4Tic Disorder F95.0-F95.9Tics and Tourette’s Disorder (TD) F95.0-F95.9
EXCLUDES F95.2
Developmental Dyslexia F81.0-F81.9Self harm X78.- A,D,S
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Comorbid Conditions for Attention-Deficit/Hyperactivity Disorder (ADHD)
Physical ICD-10-CM SpecificityEnuresis F98.0-F98.1
R32
Enuresis G40.9-Very generalized term, mostly in adults
Developmental Coordination Disorder (Clumsy) F82Fibromyalgia M79.1Legg-Calvé-Perthes Disease M91.- Depending on lateralityHypertension R45.4Height and Weight Problems Due to TreatmentEczema L30.9Allergies rhinitis NOS J30.9 Continued…
Comorbid Conditions for Attention-Deficit/Hyperactivity Disorder (ADHD)
Physical ICD-10-CM ExclusionsSleep Problems such as:sleep disordered breathing R06.3 Restless Legs Syndrome (RLS) G25.8obstructive sleep apnea (OSA) G47.33Delayed Sleep Phase Disorder G47.21periodic limb movement disorder (PLMD) G47.61
Symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in Children
Symptoms of Children ExampleOften makes careless mistakes and lacks attention to details
overlooking or missing details or handing in work that’s inaccurate
Often has difficulty paying attention to tasks or while playing
difficulty remaining focused during class, conversations, or lengthy readings
Often seems to not listen when spoken to directly
mind seems elsewhere, even in the absence of obvious distraction
Often fails to follow through on instructions, schoolwork, or chores
starts tasks but quickly loses focus and is easily sidetracked
Often has difficulty organizing tasks and activities
Examples: messy, disorganized work; poor time management
Often avoids, dislikes, or is reluctant to participate in tasks requiring sustained mental effort, like schoolwork or homeworkOften loses things like school materials or, if older, wallets, keys, eyeglasses, and mobile phonesOften easily distracted Continued…
Symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in ChildrenSymptoms of Hyperactivity and Impulsivity in Children Example
Often fidgets with or taps hands and feet or squirms in seatOften leaves seat when remaining seated is expected
leaves their place in the classroom or in other situations that require remaining seated
Often runs or climbs where it is inappropriate or feels restlessOften acts as if "on the go" or “driven by a motor”
is unable or uncomfortable being still for an extended time, as in restaurants
Often talks excessively Often blurts out an answer before a question has been fully asked
Often has difficulty waiting his or her turn while waiting in line
Often interrupts or intrudes on others
butts into conversations, games, or activities; may start using other people’s things without
asking or receiving permission
Symptoms of Attention-deficit/hyperactivity disorder (ADHD) in Adults
Symptoms of Adults ExampleOften makes careless mistakes and lacks attention to details
overlooking or missing details or handing in work that is inaccurate
Often has difficulty paying attention to tasks
difficulty remaining focused during lectures, conversations, or lengthy reading
Often seems to not listen when spoken to directly
mind seems elsewhere, even in the absence of obvious distraction
Often fails to follow through on instructions, chores, or duties in the workplace
starts tasks but quickly loses focus and is easily sidetracked
Often has difficulty organizing tasks and activities
messy, disorganized work; poor time management; fails to meet deadlines
Often avoids, dislikes, or is reluctant to participate in tasks requiring sustained mental effort, like preparing reports, completing forms, or reviewing lengthy papers Often loses things like tools, wallets, keys, paperwork, eyeglasses, and mobile phonesOften easily distracted by other things, including unrelated thoughtsOften forgetful in daily activities, such as running errands, returning calls, paying bills, and keeping appointments
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Symptoms of Attention-deficit/hyperactivity disorder (ADHD) in AdultsSymptoms of Hyperactivity and Impulsivity in Adults Example
Often fidgets with or taps hands and feet or squirms in seat
Often leaves seat when remaining seated is expected
leaves their place in the office or other workplace setting or in other situations that
require remaining seatedOften runs or climbs where it is inappropriate or feels restless (in adults, may be limited to feeling restless)Often unable to participate in leisure activities quietly
Often acts as if “on the go" or “driven by a motor”
is unable to be or uncomfortable being still for an extended time, as in meetings or
restaurantsOften talks excessivelyOften blurts out an answer before a question has been fully asked
completes people’s sentences; cannot wait for next turn in conversation
Often has difficulty waiting his or her turn, for example, while waiting in line
Often interrupts or intrudes on others
butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; may intrude
into or take over what others are doing
Causes of Attention-Deficit/Hyperactivity Disorder (ADHD) Genetic
No one knows for sure. ADHD probably stems from interactions between genes and environmental or non-genetic factors.
Researchers have found that much of the risk of having ADHD has to do with genes.
If a parent has ADHD, a child has more than a 50% chance of having it. If an older sibling has it, a child has more than a 30% chance.
ADHD is very complex and a genetic test for diagnosing the disorder is not yet available. Some studies suggest that artificial food additives and dyes may worsen
hyperactivity and inattention, but these effects are small and do not account for most cases of ADHD.
May have an imbalance in the level of neurotransmitters in the brain, or that these chemicals may not work properly. (Dopamine)
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Causes of Attention-Deficit/Hyperactivity Disorder (ADHD) Non-Genetic
Non-genetic factors that may increase a child’s risk for developing ADHD Smoking or drinking during pregnancy Birth complications or very low birth weight Exposure to lead or other toxic substances Extreme neglect, abuse, or social deprivation Food additives like artificial coloring, which might make hyperactivity worse lack of harmony between parents and in family life hostile relationships between parents and children difficulties between siblings lower socio-economic status mental health problems criminal behavior
There are certain aspects of the family environment that are found more often in children with ADHD.
Head injuries to the frontal lobe of the brain, the area that controls impulses and emotions Epilepsy
Treatment in Children for Attention-deficit/hyperactivity disorder (ADHD) Therapy Definition
Cognitive Behavior Therapy (CBT)
Also known as behavior modification, has been shown to be a very successful treatment for children with ADD / ADHD. It is especially beneficial as a co-treatment for children who take stimulant medications and may even allow you to reduce the dosage of the medication.
Social skills training
Because kids with attention deficit disorder often have difficulty with simple social interactions and struggle with low self-esteem, another type of treatment that can help is social skills training. Normally conducted in a group setting, social skills training is led by a therapist who demonstrates appropriate behaviors and then has the children practice repeating them.
Parent Training
Helped parents learn about ADHD and ways to manage ADHD behaviors. This approach included techniques by which the parents can have positive interactions with their child while becoming more effective at getting their children to meet expectations for behavior
School-Based Interventions
Helped teachers meet children’s educational needs by helping them to learn the skills to manage children’s ADHD behaviors in the classroom (such as rewards, consequences, classroom seating, and daily report cards sent to parents)
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Treatment in Children for Attention-Deficit/Hyperactivity Disorder (ADHD) Other Ways to Manage ADHD Definition
Keeping a routine and a schedule
Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
Organizing everyday items
Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
Being clear and consistent Children with ADHD need consistent rules they can understand and follow.
Giving praise or rewards when rules are followed Children with ADHD often receive and expect criticism.
Look for good behavior, and praise it.
Neurofeedback
a computer-aided training method in which selected parameters of the patient´s own brain activity, which can normally not be perceived, are made visible to the patient. Via monitor and loudspeaker the brain is shown what it is doing at the moment
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Treatment in Children for Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Stimulants
• Amphetamines
• Adderall and XR (Dextroamphetamine)• Dexedrine (dextroamphetamine)• Vyvanse (Lisdexamfetamine)• Dexedrine Spansule (dextroamphetamine)
• Methylphenidate
• Concerta (Methylphenidate)• Daytrana (methylphenidate)• Focalin and XR (Dexmethylphenidate)• Metadate ER and CD (extended release
methylphenidate)• Methylin (methylphenidate hydrochloride)• Ritalin and LA or SR (Methylphenidate)• Quillivant XR (Methylphenidate)
Non-Stimulants• Norepinephrine Uptake
Inhibitor • Strattera (Atomoxetine)
• Alpha Adrenergic Agent • Intuniv (guanfacine)• Kapvay (Clonidine)
Antidepressants
• Wellbutrin (Buproprion Hydrochloride) • Tofranil (Imipramine)• Pamelor (Nortriptyline)• Lexapro (Escitalopram)
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Treatment in Children for Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Stimulants
• Amphetamines
• Adderall and XR (Dextroamphetamine)• Dexedrine (dextroamphetamine)• Vyvanse (Lisdexamfetamine)• Dexedrine Spansule (dextroamphetamine)
• Methylphenidate
• Concerta (Methylphenidate)• Daytrana (methylphenidate)• Focalin and XR (Dexmethylphenidate)• Metadate ER and CD (extended release
methylphenidate)• Methylin (methylphenidate hydrochloride)• Ritalin and LA or SR (Methylphenidate)• Quillivant XR (Methylphenidate)
Non-Stimulants• Norepinephrine Uptake
Inhibitor • Strattera (Atomoxetine)
• Alpha Adrenergic Agent • Intuniv (guanfacine)• Kapvay (Clonidine)
Antidepressants
• Wellbutrin (Buproprion Hydrochloride) • Tofranil (Imipramine)• Pamelor (Nortriptyline)• Lexapro (Escitalopram)
Treatment in Adults for Attention-Deficit/Hyperactivity Disorder (ADHD) Therapy
Psychotherapy (also called talk therapy, therapy, or counseling)
a process focused on helping you heal and learn more constructive ways to deal with the problems or issues within your life
Cognitive Behavior Therapy
a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression
Relaxation training and stress management Relaxation training and stress management
Life coaching It may help you set goals. Plus, it can help you learn new ways to stay organized at home and work.
Job coaching or mentoringThis can help support you at work. It can help you have better working relationships and improve on-the-job performance.
Family education and therapyThis can help you and loved ones understand ADHD better. It can also help you all find ways to lessen how much it affects everyone’s life.
Neurofeedback
a computer-aided training method in which selected parameters of the patient´s own brain activity, which can normally not be perceived, are made visible to the patient. Via monitor and loudspeaker the brain is shown what it is doing at the moment
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Treatment in Adults for Attention-Deficit/Hyperactivity Disorder (ADHD) Other Ways to Manage ADHDOrganizeBreathe slowlyCut down on distractionsBurn off extra energy (Exercise)
Diet
• Add more omega-3 fatty acids to your diet• Schedule regular meals or snacks no more than three
hours apart • Make sure you’re getting enough zinc, iron, and
magnesium in your diet• Try to include a little protein and complex carbohydrates
at each meal or snack• Add more omega-3 fatty acids to your diet
MeditationYoga Continued…
Treatment in Adults for Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Stimulants
• Amphetamines
• Adderall and XR (Dextroamphetamine)• Dexedrine (dextroamphetamine)• Vyvanse (Lisdexamfetamine)• Dexedrine Spansule (dextroamphetamine)
• Methylphenidate
• Concerta (Methylphenidate)• Daytrana (methylphenidate )• Focalin and XR (Dexmethylphenidate)• Metadate ER and CD (extended release
methylphenidate)• Methylin (methylphenidate hydrochloride)• Ritalin and LA or SR (Methylphenidate)• Quillivant XR (Methylphenidate)
Eugeroic (wakefulness-promoting agent) • Provigil (Modafinil)Nonstimulants
• Norepinephrine Uptake Inhibitor • Strattera (Atomoxetine)
• Alpha Adrenergic Agent • Intuniv (guanfacine)• Kapvay (Clonidine)
Antidepressants
• Wellbutrin SR and XL (Buproprion Hydrochloride)• Tofranil (Imipramine)• Pamelor (Nortriptyline)• Norpramin (Desipramine HCL)• Lexapro (Escitalopram)
Documentation of Attention-Deficit/Hyperactivity Disorder (ADHD) Documentation
Personal demographics
• Name• Nickname or
aliases• Age/ Date of
Birth• Address• Phone• Email
• Gender• Sexual
Orientation• Relationship
status• Religious
preference (if any)
• Ethnicity
Primary Care Physician
• Address• Phone• Last Physical
Exam
Family history• Mental
Disorders
Documentation
Personal History
• Last Psych Diagnosis, treatment plan (if previously treated)
• Use of drugs • Types,• How long• How much
• Use of Alcohol• How much
• Smoker• How much
• Surgeries • Allergies• Vitals
• Weight• Height• BP
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Documentation of Attention-Deficit/Hyperactivity Disorder (ADHD) Documentation
Psychiatric Testing
• Screen for mental illnesses
• Documentation of underlying emotional issues
• Social worker documentation
• (See also SYMPTOMS Tab)
Medication records
• General records from PCP
Documentation
Treatment plan • Therapy• Weekly• Bi-weekly• As Needed
• Medications
• Type• Dose• When to
take• Side
Effects
• Follow up plan
• 1 month• 3 months• 6 months
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Documentation of Attention-Deficit/Hyperactivity Disorder (ADHD) Documentation
Physician visits• Regular physician visits to safeguard
physical health
• Documentation of symptoms such as mood disorders, anxiety disorders and personality disorders
• Suicide ideation
• Substance abuse
Documentation
Diagnosis
Attention-deficit/hyperactivity disorder (ADHD) Type:
o Predominantly Inattentive Type
o Predominantly Hyperactive-impulsive Type
o Combination Type
Comorbid conditions
Labs• (depending on
medications)• Blood• Liver• Cardio
Resources for this project on Attention-Deficit/Hyperactivity Disorder (ADHD)
Symptoms http://www.vyvanse.com/adhd-adult-symptoms
Causes http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-easy-to-read/index.shtml#pub4
http://www.webmd.com/add-adhd/guide/adhd-causes
http://psychcentral.com/lib/causes-of-attention-deficit-disorder-adhd/
http://www.netdoctor.co.uk/conditions/adhd/a5225/what-causes-adhd/
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/add-adhd/possible-causes-of-adhd-attention-deficit-hyperactivity-disorder?view=slideview
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Resources for this project on Attention-Deficit/Hyperactivity Disorder (ADHD)
Description https://www.medicalhomeportal.org/diagnoses-and-conditions/attention-deficit-h
yperactivity-disorder http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518387/ http://qz.com/592364/decades-of-failing-to-recognize-adhd-in-girls-has-created-a
-lost-generation-of-women/Codes http://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F90-/F90.0
http://psychcentral.com/disorders/dsm-iv-diagnostic-codes/#adhd www.medicalhomeportal.org/diagnoses-and-conditions/attention-deficit-hyperact
ivity-disorder DSM V Page 59-65
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Resources for this project on Attention-Deficit/Hyperactivity Disorder (ADHD)
Comorbidity www.mentalhelp.net/articles/adhd-comorbidity
Treatment• ADULT www.webmd.com/add-adhd/adhd-adults?page=3#2
www.helpguide.org/articles/add-adhd/adult-adhd-attention-deficit-disorder-treatment.htm http://psychcentral.com/lib/treatment-for-adhd/
www.chadd.org/Understanding-ADHD/For-Adults/Treatment/Medication-Management.aspx• CHILDRE
N www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-treatment-in-children.htm
www.webmd.com/add-adhd/childhood-adhd/adhd-children?page=2#2 file:///C:/Users/danal/Downloads/adhd-parents-medication-guide.pdf www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/i
ndex.shtml
Thank you!All information was gathered and researched by a non clinical student, some information may be left out, or incorrect due to advances in medical science, and mental health information.
Dana L. Anderson
