Health Information Management

Notice the notes when coding autism

HIM-HIPAA Insider, March 16, 2015

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A new article in the Journal of the American Medical Association (JAMA) Psychiatry shows a strong link between genetics and autism. That’s not an unusual or completely unexpected outcome. Scientists have known for some time that genetics plays a role in autism. The new study suggests genetic influences on autism to be between 74%–98%. You have to be a JAMA Psychiatry subscriber to read the complete article, but BBC News helpfully reported on the findings.
While scientists and physicians aren’t sure of the exact cause of autism, they—and the general public—do know that physicians are more commonly diagnosing autism. Keep in mind that autism is a spectrum of disorders, not a single condition. Some patients are mildly impaired by their symptoms, while others are severely disabled.
ICD-9-CM offers one code for autism with two possible fifth digits:
  • 299.00, autistic disorder, current or active state
  • 299.01, autistic disorder, residual state
If the state is unspecified, default to 0.
We do have one additional code choice for Asperger’s syndrome—299.8x (other specified pervasive developmental disorder). You will use either a 0 or 1 as the fifth digit just as you do for autism.
Since ICD-10-CM is more detailed, you might expect to find more code choices. Actually, you don’t.
In ICD-10-CM, we will report F84.0 (autistic disorder) for patients diagnosed with autism.
Under F84.0, we see an Excludes1 note for Asperger’s syndrome. Excludes1 means the conditions are mutually exclusive. If the patient has one, he or she can’t have the other. As usual, that makes perfect sense in this case. Asperger’s syndrome is part of the autism spectrum.
In ICD-10-CM, we’ll use F84.5 for Asperger’s syndrome.
Atypical autism falls under F84.9 (pervasive developmental disorder, unspecified).
One difference with ICD-10-CM is the “Use additional code” note under F84.0. The note instructs us to identify any associated medical condition and intellectual disabilities with an additional code (or codes, depending on the patient’s condition).
We don’t have that note in ICD-9-CM, so in ICD-10-CM, we will get a better understanding of the patient’s level of impairment.
This article originally appeared on HCPro’s ICD-10 Trainer blog.


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