What is the appropriate ICD-10 (International Classification of Diseases, 10th Revision) code for a referral to psychiatry for a child or adolescent with suspected Attention Deficit Hyperactivity Disorder (ADHD)?

ICD-10 Code for Psychiatry Referral for ADHD Evaluation

For a referral to psychiatry for suspected ADHD evaluation, use the unspecified ADHD code F90.9 (314.01) until a comprehensive diagnostic evaluation determines the specific ADHD presentation. 1, 2

Appropriate ICD-10 Coding Strategy

Initial Referral Code

• F90.9 (Attention-deficit/hyperactivity disorder, unspecified) is the appropriate code when referring for evaluation before a definitive diagnosis has been established 3
• This unspecified code should be used when ADHD is suspected but DSM-5 criteria have not yet been fully documented across multiple settings 3

After Diagnostic Evaluation

Once the psychiatrist completes a comprehensive evaluation meeting DSM-5 criteria, the code should be updated to reflect the specific presentation 1, 2:

• F90.0 (314.00): ADHD, predominantly inattentive presentation 1, 2
• F90.1 (314.01): ADHD, predominantly hyperactive-impulsive presentation 1, 2
• F90.2 (314.01): ADHD, combined presentation 1, 2
• F90.8 (314.01): ADHD, other specified 1, 2

Critical Documentation Requirements for Referral

Essential Information to Include

The referral should document specific symptoms observed to justify the psychiatric evaluation 1:

• Inattention symptoms: Difficulty sustaining attention, easily distracted, fails to follow through on tasks, loses things necessary for activities 1, 4
• Hyperactivity-impulsivity symptoms: Fidgets, leaves seat inappropriately, runs/climbs excessively, talks excessively, interrupts others 1, 4
• Settings where impairment occurs: Academic performance problems, behavioral issues at home, social difficulties 1
• Duration: Symptoms present for at least 6 months 4
• Age considerations: For children ages 4-18 years presenting with academic or behavioral problems 1

Comorbidity Screening Results

Document any screening for conditions that may complicate diagnosis 5:

• Emotional/behavioral conditions (anxiety, depression, oppositional defiant disorder) 5, 6
• Developmental conditions (learning disabilities, language disorders, autism spectrum disorders) 5, 6
• Physical conditions (tics, sleep disorders) 5, 6

Common Pitfalls to Avoid

Coding Errors

• Do not use specific presentation codes (F90.0, F90.1, F90.2) before comprehensive evaluation is complete, as this requires documentation of DSM-5 criteria with information from multiple sources across multiple settings 1, 3
• Avoid using outdated terminology like "ADD" in documentation; always use "ADHD" with the appropriate presentation specifier 2

Documentation Gaps

• Failing to document impairment in more than one setting (home, school, social) makes the referral less actionable 1
• Not including information from teachers or other observers weakens the clinical justification 1, 5

Age-Specific Considerations

Preschool-Aged Children (4-5 years)

• F90.9 is appropriate for referral, but note that evidence for diagnosis in this age group requires careful evaluation 1
• Consider referral for parent training in behavior management even without definitive diagnosis 1

School-Aged Children and Adolescents (6-18 years)

• F90.9 for initial referral with expectation that psychiatrist will establish specific presentation code 1, 4
• For adolescents (12-18 years), at least 5 symptoms from either category are required for diagnosis 4
• Symptom onset must have occurred before age 12 years 4