Autism Diagnosis and ICD-10-CM

Autism Diagnosis and ICD-10-CM

A recent report from US News was published regarding an October article in the Journal of the American Medical Association (JAMA) about the increase in autism.

The ICD-10-CM classification helps to aid in capturing this diagnosis which we know then drives the clinical data that is extremely valuable in understanding the frequency trends of this and other conditions.

The JAMA article shows that there are increases in new autism diagnoses among young adults, as well a rise in diagnoses for girls and young women. These increases have driven a near-tripling of U.S. autism cases in just over a decade, researchers report.

Data collected on more than 12 million patients enrolled in major U.S. health care systems found that between 2011 and 2022 the number of people diagnosed with autism climbed by 175 percent, according to a study published Oct. 30 in the journal JAMA Network Open.

The rise in diagnoses was especially dramatic among young adults ages 26 to 34 — this group experienced a 450percent increase (equivalent to more than a 5.5 times rise) in autism diagnoses between 2011 and 2022, the report found.

These facts made me want to learn more about Autism. I found some great information on the “Neurolaunch” website which states: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by persistent challenges in social communication and interaction, along with restricted and repetitive patterns of behavior, interests, or activities. The spectrum nature of autism means that individuals can present with a wide range of symptoms and severity levels, making accurate diagnosis both crucial and challenging.

Now turning to the ICD-10-CM, the system classifies “AUTISM” in Chapter 5 Mental, Behavioral and Neurodevelopmental disorders (F01-F99). When looking up the word “Autism” in the alphabetic index there are three entries which represents two code choices, F84.0 infantile and F84.9 atypical:

Autism, autistic (childhood) (infantile) F84.0

  • atypical F84.9
  • spectrum disorder F84.0

Going next to the tabular, we see F84 Pervasive developmental disorders and an instruction to 
“Code also any associated medical condition and intellectual disabilities.”

Then under the specific code F84.0 we will see the following:
F84.0 Autistic disorder

  • Autism spectrum disorder
  • Infantile autism
  • Infantile psychosis
  • Kanner’s syndrome

Excludes1: Asperger’s syndrome (F84.5)

Also in the tabular the code F84.9 Pervasive developmental disorder, unspecified. There is an inclusion term of:
Atypical autism

There are many synonyms or lay terms that might be used by providers when documenting the condition, so read over carefully the documentation as well as the signs/symptoms that the patient is demonstrating before assigning the correct diagnosis code.  If there is conflicting, contrasting, limited, missing documentation or even a diagnosis without supporting clinical indicators the coding and/or clinical documentation integrity specialists (CDISs) should query the provider. When querying, remember to utilize and follow the AHIMA/ACDIS Practice Brief on compliant querying.

The ICD-10-CM descriptions and category indicates the varying manifestations of autism. Remember always that the health record documentation and accurate medical coding creates more precise data, treatment planning, and even aides in research.

I know HIM and CDISs enjoy learning more about diagnoses, so I hope this short article was helpful. There is additional information within the website “Neurolaunch” which I would recommend reading over.  Also to learn more about autism spectrum disorders go to Autism Speaks

ICD-10-CM drives clinical data and is thus a wonderful component to the current and future diagnosing and treatment of many conditions.

Programming note:

Listen to Gloryanne Bryant as she reports this story live today on Talk Ten Tuesday, 10 Eastern, with Chuck Buck and Dr. Erica Remer.

Facebook
Twitter
LinkedIn

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS

Gloryanne is an HIM coding professional and leader with more than 40 years of experience. She has an RHIA, CDIP, CCS, and a CCDS. For the past six years she has been a regular speaker and contributing author for ICD10monitor and Talk Ten Tuesdays. She has conducted numerous educational programs on ICD-10-CM/PCS and CPT coding and continues to do so. Ms. Bryant continues to advocate for compliant clinical documentation and data quality. She is passionate about helping healthcare have accurate and reliable coded data.

Related Stories

Washington Carries On

Washington Carries On

As the November elections neared, you might have expected Washington to slow to a crawl amidst campaigning and uncertainty about the future. However, the show

Read More
Coding for Halloween

Coding for Halloween

EDITOR’S NOTE: With Halloween on the radar, ICD10monitor Contributor Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for the St. Louis-based First

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.

November 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Outpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

September 5, 2024
Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.

September 12, 2024

Trending News

Featured Webcasts

Patient Notifications and Rights: What You Need to Know

Patient Notifications and Rights: What You Need to Know

Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.

December 5, 2024
Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks.  Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.

November 19, 2024
Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.

October 24, 2024
The OIG Update: Targets and Tools to Stay in Compliance

The OIG Update: Targets and Tools to Stay in Compliance

During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.

September 19, 2024

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!