ADHD treatment and diagnosis billing doesn’t have to be a mystery. But for most healthcare providers, it can be confusing to navigate ICD-10 codes, ADHD diagnosis code, and insurance reimbursement. One coding error or lack of documentation can slow down payments, result in claim denials, and leave patients scrambling to receive the care they deserve.
This guide contains all you need to know about ADHD diagnosis code, from the proper process to best practices in billing that will have claims rolling in.
Cracking the Code: ADHD Diagnosis in ICD-10
The ICD-10 system breaks down ADHD into distinct categories based on the symptoms of the patient. Proper use of the code ensures proper diagnosis and treatment planning. A handy reference cheat sheet of the ICD-10 codes for ADHD follows:
- F90.0: Predominantly inattentive type (trouble paying attention, forgetfulness, distractibility)
- F90.1: Predominantly hyperactive-impulsive type (excessive fidgeting, impulsivity)
- F90.2: Combined type (inattentive + hyperactive)
- F90.8: Other specified ADHD
- F90.9: Unspecified ADHD
Selecting the right diagnosis code is step one to ensuring claims go through smoothly and insurance companies don’t battle.
How to Bill for ADHD Diagnosis Code: Getting CPT Codes Right
After the ADHD diagnosis is established, it’s time to bill for treatment, evaluation, and follow-up visits. That’s where CPT codes enter the picture. These codes inform insurers exactly what services were rendered, whether it’s a consultation, diagnostic testing, or routine therapy.
CPT Codes for ADHD Evaluations
- 99202–99205: New patient office visits
- 99212–99215: Follow-up office visits
- 96127: Short behavioral/emotional rating scale (Vanderbilt ADHD Scale, etc.)
- 96130–96131: Report of psychological testing (initial hour & remaining time)
CPT Codes for ADHD Treatment & Follow-Up
- 90832–90834: Individual treatment
- 90847: Family therapy with patient in attendance
- 96116: Neurobehavioral status exam (testing reason, judgment, cognition)
- G0459: Telemedicine ADHD assessment
Employing the correct CPT codes allows for correct reimbursement to providers for services related to ADHD and minimizes insurance denials. A billing service can have the claims for ADHD accurately coded, minimizing errors and maximizing reimbursement rates.
What Insurers Want to See: Documentation Must-Haves
Proper documentation is not record-keeping on patient files, it’s your first line of defense against claim denial. The following is what insurers need to see on the patient file:
- Thorough symptom history, including onset time, intensity, and effect on functional ability
- Assessment measures such as Vanderbilt ADHD Rating Scale and Conners Scale
- Comorbid conditions such as learning disabilities, anxiety, or depression
- Treatment plan, such as drugs, therapy sessions, and behavior modification
- Follow-up information such as medication changes, progress, and side effects
If documentation is good, comprehensive, and complete, payment will be prompt and insurance claims disputes eliminated. A medical billing service sees to it that understanding is in the correct form for all claims that results in fewer denials.
Don’t Make These ADHD Diagnosis Code Billing Mistakes
Even small errors in billing can lead to a payment delay or overturned claim. The most frequent pitfalls and how to be one step ahead of them are listed below:
- Lack of medical necessity: Payors want to see that ADHD is disrupting the patient’s daily routine. Utilizing proven and trusted tools to evaluate them might be able to support the diagnosis.
- Coding mistake: Do not mix up CPT 96127 (short behavioral assessment) with 96130 (psychological evaluation). Double-check always before submission.
- Not documenting follow-up: When medicating a patient with ADHD, insurance providers must be able to see follow-up and monitoring evidence.
- Not following telehealth billing guidelines: For telemedicine ADHD, bill under G0459 and ensure the patient’s insurance policy covers virtual visits.
Coding mistakes are the largest reasons for claims denials or delays. Medical billing coding can be managed easily by a medical billing service, relieving healthcare providers of administrative burden.
Best Practices for Smooth Flow of ADHD Claims
For faster payment and fewer denials, use these best practices:
- Verify insurance prior to treatment to ensure coverage for ADHD evaluation, treatment, and medication.
- Employ standardized screening instruments to enhance claim acceptance opportunities.
- Keep good documentation with extensive patient notes and progress monitoring.
- Partner with a medical billing company to reduce claim denials and maximize revenue.
Why ADHD Billing is Important to Healthcare Providers
Precise billing of ADHD diagnosis and treatment is important to patients as well as to healthcare providers.
- Reimbursement faster equates to fewer dollars of provider financial stress
- Fewer denied claims save revenue for clinics
- Accurate documentation facilitates increased patient care
- Patients benefit from timely treatment without insurance roadblocks
It’s not all about being productive—medical billing coding for ADHD directly affects the outcome of patient care and the revenue of a clinic.
Your Partner of Choice for ADHD Billing & Coding
It is not always easy to handle ADHD medical billing coding, but expert assistance guarantees smooth claim processing and quick reimbursements. From CPT billing to insurance compliance and ICD-10 coding, a professional medical billing service streamlines the process and increases practice revenues.
Maximize Your ADHD Billing Today with Precision Hub
Maintain your focus on providing great care while experts handle your medical billing and coding. With customized solutions, medical professionals can stay ahead of changing regulations and simplify revenue cycle management. Contact our team at Precision Hub today and learn how superior billing support can increase your practice’s financial success.
