ICD-10 Code for Asperger's Syndrome Testing
For testing and evaluation of Asperger's syndrome, use ICD-10 code F84.5 (Asperger's syndrome), though note that as of DSM-5, this diagnosis has been subsumed under Autism Spectrum Disorder (F84.0), which may have better insurance approval rates for genetic testing. 1
Current Diagnostic Classification Context
The diagnostic landscape for Asperger's syndrome has evolved significantly:
- Asperger's syndrome is classified under ICD-10 code F84.5, which remains valid for billing and diagnostic purposes despite changes in DSM-5 2, 3
- DSM-5 eliminated Asperger's syndrome as a separate entity, merging it into Autism Spectrum Disorder (ASD), though ICD-10 still maintains the distinction 2, 4
- For insurance authorization purposes, using F84.0 (Autism) may yield higher approval rates for genetic testing, particularly for chromosomal microarray (CMA) testing, based on data from 4,500 prior authorizations 1
Practical Coding Recommendations
When submitting for genetic or diagnostic testing:
- Use F84.5 if the clinical presentation specifically matches Asperger's syndrome with no language delay and specific cognitive profile 5
- Consider using F84.0 (Autism Spectrum Disorder) for genetic testing authorization, as this code demonstrated higher approval rates in large-scale insurance studies 1
- The choice of diagnostic code did not significantly influence prior authorization outcomes except for F84.0 with CMA testing, which had notably better approval 1
Testing Coverage Considerations
Insurance companies often reference outdated guidelines that recommend CMA as first-line testing for ASD (F84.0), which explains the higher approval rate for this code 1
For comprehensive genetic evaluation in suspected Asperger's/ASD:
- Chromosomal microarray is recommended as first-tier testing with approximately 10% diagnostic yield 1
- Fragile X DNA testing should be performed routinely for males (1-5% yield) 1
- MECP2 sequencing for all females with ASD (4% yield in females) 1, 6
Common Pitfalls
- Avoid using only F84.5 when seeking genetic testing authorization, as payers may deny based on lack of specific coverage policies for this code versus F84.0 1
- Do not assume all ICD-10 codes have equal insurance acceptance for specialized testing—F84.0 has demonstrably better approval rates 1
- Recognize that late diagnosis is common (average age 11 years), so adult evaluations may require additional documentation to justify testing 5