Billable ICD-10-CM Code for Attention Deficits Pending ADHD Confirmation
Use ICD-10-CM code F90.8 ("Attention-deficit hyperactivity disorder, other type" or "Other specified ADHD") when billing for a patient presenting with attention-deficit symptoms while the full ADHD diagnostic work-up is still in progress. 1
Rationale for F90.8
- The American Academy of Pediatrics explicitly recognizes F90.8 as the appropriate code for "other specified and unspecified ADHD" within the DSM-5 classification system used by primary care clinicians and third-party payers 1
- This code allows you to document and bill for the clinical encounter while you are still gathering the required multi-setting information (parent reports, teacher rating scales, collateral history) needed to confirm one of the three primary ADHD presentations 1
- F90.8 is billable when DSM-5 criteria are not yet fully met because you lack documentation of impairment in more than one major setting or have not yet ruled out alternative causes 1
When to Transition to a Definitive Code
Once your diagnostic work-up is complete and DSM-5 criteria are satisfied, transition to one of the three primary codes based on symptom pattern:
- F90.0 (314.00): Predominantly Inattentive Presentation—when ≥6 inattention symptoms are present with <6 hyperactive-impulsive symptoms 1, 2
- F90.1 (314.01): Predominantly Hyperactive-Impulsive Presentation—when ≥6 hyperactive-impulsive symptoms are present with <6 inattention symptoms 1, 2
- F90.2 (314.01): Combined Presentation—when ≥6 symptoms are present in both domains 1, 2
Required Documentation to Support F90.8
To justify F90.8 billing while awaiting full confirmation, document the following in your clinical note:
- Presenting symptoms that raise concern for ADHD (e.g., poor attention to detail, difficulty sustaining attention, organizational challenges, forgetfulness) 3
- Pending collateral information from teachers, parents, or other observers using DSM-5-based rating scales such as Vanderbilt scales 2
- Plan to verify symptom onset before age 12, duration ≥6 months, and impairment across ≥2 settings (home, school, work) 1, 3
- Differential diagnoses being considered, such as anxiety, depression, learning disorders, or sleep disorders that can mimic ADHD 2, 4
Common Pitfalls to Avoid
- Do not use F90.8 indefinitely—it is a temporary code while diagnostic work-up is in progress; prolonged use without completing the evaluation may trigger payer audits 1
- Do not assign a definitive ADHD code (F90.0, F90.1, F90.2) prematurely before confirming DSM-5 criteria, as this requires documented impairment in multiple settings and ruling out alternative explanations 1
- Avoid using unspecified symptom codes (e.g., R41.840 for "attention and concentration deficit") when ADHD is the suspected diagnosis, as F90.8 more accurately reflects your clinical suspicion and is better recognized by payers for ADHD-related services 1
Special Consideration for Preschool-Aged Children (4–6 Years)
- For children younger than 4 years, there is insufficient evidence to recommend diagnosis or treatment other than parent training in behavior management, which does not require an ADHD diagnosis code 1
- For ages 4–6 years, F90.8 can be used while gathering information through clinical interviews with parents, direct observation, and DSM-based rating scales with preschool normative data 1