Attention-Deficit/Hyperactivity Disorder (ADHD) has experienced changes in terminology and diagnostic criteria over the years. This article examines the evolution of the term "ADD" and its current place in the ICD-10, a system used worldwide that classifies various mental health conditions.

We’ll also look at why precise coding matters for treatment planning, reimbursement, and communication among professionals. You'll gain a clearer view of how to navigate the ICD-10 code when looking for an ADD diagnosis.

Defining F90.0: Predominantly Inattentive Presentation

ADD is an outdated term for Attention-Deficit/Hyperactivity Disorder (ADHD). While some people may still use "ADD" colloquially, especially to refer to the inattentive type of ADHD, the official and updated term is ADHD, which encompasses all forms of the disorder, including hyperactivity and impulsivity. The American Psychiatric Association formally changed the term “ADD” to “ADHD” in 1987, and the Diagnostic and Statistical Manual of Mental Disorders (DSM) no longer recognizes ADD as a distinct diagnosis.

Because of this, the ICD-10 does not formally list ADD, but instead lists the predominantly inattentive presentation of ADHD under the code F90.0 – Attention-Deficit Hyperactivity Disorder, predominantly inattentive type. This presentation features clinical signs of inattention without significant hyperactivity or impulsivity. So if a client presents with “ADD” symptoms, they will likely fall within this diagnostic code.Key symptoms of F90.0 include forgetfulness, distractibility, poor sustained attention, and disorganization. These symptoms match the predominantly inattentive presentation of ADHD in the DSM-5, allowing for cross-referencing between the two diagnostic systems.

Differential Diagnosis and Related ICD‑10 Codes

Diagnosing predominantly inattentive ADHD (formerly known as ADD) accurately means specifying the ADHD type, and distinguishing it from similar conditions.  Here are some important ICD-10 codes to keep in mind:

• F90.1 (Hyperactive/Impulsive type): This ADHD type involves restlessness, impulsivity, and disruptive behaviors without significant issues with inattention.
• F90.2 (Combined presentation): This code applies to ADHD with both inattentive and hyperactive-impulsive symptoms.
• F84.x (Autism Spectrum Disorder): ASD might include attention difficulties and could be confused with ADD. However, ASD also involves challenges with social communication and repetitive behaviors.
• F81.x (Specific learning disorders): Learning disabilities in areas like reading, writing, or math can affect academic performance and appear similar to inattention. A thorough assessment can differentiate between ADD and learning disorders.
• F32.x (Depressive episodes): Depression can lead to concentration problems and a lack of interest in activities, which may resemble ADD. Checking for mood symptoms is important.

Comorbidities often occur with ADHD and can make diagnosis and treatment more complex. Some commonly co-occurring conditions include:

• Anxiety disorders (F41.1): Anxiety can increase inattention and worsen overall functioning.
• Oppositional defiant disorder (F91.3): ODD involves a pattern of defiant, disobedient, and hostile behavior towards authority figures.
• Sleep disorders (F51.x): Sleep problems can increase ADHD symptoms and should be part of a comprehensive treatment plan.

Assessment and Diagnostic Tools

Diagnosing ADHD accurately involves a thorough assessment process. Mental health professionals should rely on a mix of clinical interviews, rating scales, and reports from various sources, such as teachers and caregivers, to gather a complete picture of the client's symptoms and functioning.

Some widely used and validated assessment instruments for ADHD include:

• Vanderbilt ADHD Diagnostic Rating Scales: These scales, available in parent and teacher versions, assess the frequency and severity of ADHD symptoms in different settings.
• Conners' Rating Scales: The Conners' scales come in various forms and evaluate ADHD symptoms and common comorbidities in children, adolescents, and adults.
• Clinical interviews: Structured or semi-structured interviews with the client, family members, and other relevant parties (e.g., teachers, partners) provide valuable information about the onset, duration, and impact of symptoms.

Additional data from academic records, work performance evaluations, and direct observations can further inform the diagnostic process.

When documenting ADHD symptoms for ICD-10 coding, clinicians should ensure their assessment findings match the specific diagnostic criteria for F90.0. This includes:

• Noting at least six symptoms of inattention that have persisted for at least six months
• Confirming that these symptoms are inconsistent with the client's developmental level and negatively impact academic, occupational, or social functioning
• Specifying that the symptoms do not occur exclusively during a psychotic disorder or other mental disorder

Clear, detailed documentation of these criteria is important for accurate coding and facilitating appropriate treatment planning and reimbursement.

Treatment Considerations for F90.0 Clients

Treating Predominantly Inattentive ADHD (F90.0) effectively often requires a combination of evidence-based psychotherapy, medication management, and educational support. Mental health professionals should design treatment plans that address each client's specific needs, taking into account their age, symptom severity, and overall functioning.

Psychotherapeutic approaches with strong research backing for ADD include:

• Behavioral therapy: Techniques like positive reinforcement, goal-setting, and changes to the environment can assist clients in developing adaptive behaviors and lessening the impact of ADHD symptoms on everyday life.
• Executive function coaching: Improving organization, time management, and problem-solving skills is important for clients dealing with the inattentive aspects of ADHD.
• Parent training: When working with children and adolescents with ADHD, involving parents in treatment is very important. Therapists can guide parents on how to create structured home environments, use consistent discipline strategies, and encourage positive parent-child interactions.

In many situations, medication can effectively complement psychotherapy for clients with ADHD. Stimulant medications (e.g., methylphenidate, amphetamines) are often the first choice due to their proven ability to reduce inattentive symptoms. Non-stimulant options, such as atomoxetine or guanfacine, may be advised for clients who can't tolerate stimulants or have certain coexisting conditions. Mental health providers should collaborate closely with medical professionals to monitor the effects and side effects of any prescribed medications.

School-based interventions also play an important role in comprehensive ADHD treatment, especially for children and adolescents. Therapists can partner with school personnel to develop 504 plans or Individualized Education Programs (IEPs) that offer accommodations and support services tailored to the student's needs. Common accommodations for students with ADHD include:

• Extra time on tests and assignments
• Preferential seating to minimize distractions
• Use of assistive technology (e.g., note-taking apps, audiobooks)
• Modified homework or classwork assignments

Through a combination of targeted psychotherapy, carefully managed medication, and appropriate educational accommodations, mental health professionals can equip clients with ADHD to successfully navigate their daily lives.

Coding, Documentation, and Insurance Relevance

When documenting ADHD for insurance purposes, using the most specific ICD-10 code is important. F90.0 (predominantly inattentive type) should be used when the clinical presentation aligns with this subtype, rather than the less specific F90.9 (attention-deficit hyperactivity disorder, unspecified type). Accurate coding ensures proper reimbursement and helps justify the medical necessity of treatment.

Charting language should clearly describe the client's symptoms, functional impairments, and how ADHD affects their daily life. Key areas to address include:

• Academic or occupational functioning: Describe how inattention, disorganization, or forgetfulness impact the client's performance at school or work.
• Social relationships: Note any difficulties the client experiences in social situations due to ADHD symptoms, such as trouble following conversations or frequently losing track of important details.
• Daily living skills: Highlight challenges with managing household tasks, keeping appointments, or maintaining personal hygiene due to ADHD.

When providing ADD treatment via telehealth, specific coding considerations apply:

• Telehealth modifiers: Append the appropriate modifier (e.g., GT, 95) to CPT codes to indicate that the service was delivered via telehealth.
• Place of service (POS) code: Use POS code 02 for telehealth services, indicating that the service was provided or received through a telecommunication system.
• Documentation requirements: Clearly document the type of telehealth service (e.g., video, phone), the platform used, the duration of the session, and any technical difficulties encountered. Obtain and record the client's consent for telehealth treatment.

As telehealth becomes increasingly common, staying up-to-date on payer policies and state regulations is important to ensure compliance and proper reimbursement for ADHD treatment provided via remote platforms.

Special Populations and Developmental Trajectories

While ADHD, predominantly inattentive type(F90.0) can affect people of all ages and backgrounds, some groups may encounter unique obstacles in the diagnosis and treatment process. One such group is females, who often show different symptoms than males and may be underdiagnosed as a result.

Research indicates that females with ADHD are more likely to show inattentive symptoms, such as:

• Difficulty paying attention to details: Females with ADHD may find it hard to focus on tasks or conversations, leading to simple mistakes or appearing "distracted."
• Forgetfulness and disorganization: Females with ADHD commonly face challenges with time management, losing important items, and feeling scattered.
• Emotional dysregulation: Females with ADHD often report higher rates of anxiety, depression, and stress, complicating the diagnostic picture.
• Somatic presentation: Females with ADHD may report more somatic complaints like headaches, migraines, stomach aches, and nausea.

Misdiagnosis or delayed diagnosis poses a significant issue for females with ADD. Traditional diagnostic criteria and assessment tools may not fully capture the unique presentation of ADHD in this group, leading to missed opportunities for early intervention and support.

As individuals with ADHD progress into adolescence and adulthood, the persistence of symptoms can significantly impact academic, occupational, and social functioning. College students with ADHD may struggle with the increased demands of higher education, while adults may face challenges in the workplace related to organization, time management, and interpersonal relationships.

Cultural factors also affect the recognition and treatment of ADHD. Attitudes towards mental health, expectations for behavior, and access to resources can all influence whether a person seeks help for attention-related concerns. Mental health professionals should strive to provide culturally responsive assessment and intervention services that consider the unique experiences and perspectives of diverse populations.

Understanding the special considerations for diverse individuals with ADHD allows mental health providers to work towards reducing disparities in diagnosis and treatment access. This may involve:

• Tailoring assessment procedures: Using measures that are sensitive to the unique presentation of ADHD in specific groups.
• Providing psychoeducation: Helping individuals and families understand the nature of inattentive ADHD and how it may manifest differently across the lifespan and in various cultural contexts.
• Collaborating with other professionals: Partnering with educators, primary care providers, and community organizations to identify and support individuals with ADHD who may be underserved.

Resources for Clinicians

Keeping up with the latest diagnostic guidelines and treatment approaches is important for mental health professionals working with clients with ADHD (F90.0). Here are some helpful resources to support your clinical practice:

• ICD-10 codebook and diagnostic guidelines: Access the most recent version of the ICD-10 codebook and get familiar with the specific diagnostic criteria for F90.0. The World Health Organization (WHO) offers a comprehensive online platform for navigating the ICD-10 system.
• Continuing education programs: Participate in ADHD/ADD-focused training through accredited providers like the American Psychological Association (APA), the National Association of Social Workers (NASW), and the American Counseling Association (ACA). Look for courses that cover assessment, treatment planning, and evidence-based interventions for ADHD.
• Professional organizations: Join groups like the Attention Deficit Disorder Association (ADDA) or Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) to access webinars, conferences, and other learning opportunities specific to ADD/ADHD.
• Clinical toolkits: Make use of pre-made templates and handouts to streamline your assessment and documentation process. Many professional organizations and continuing education providers offer downloadable resources, such as symptom checklists, treatment planning guides, and client education materials.
• Journal articles and research databases: Stay informed about the latest research findings and best practices for ADHD treatment by regularly reviewing peer-reviewed journals like the Journal of Attention Disorders or the Journal of the American Academy of Child & Adolescent Psychiatry. Use research databases like PubMed or PsycINFO to search for relevant studies and meta-analyses.

Focusing on ongoing education and gathering resources can help ensure that your clinical skills remain sharp and aligned with the most current knowledge for diagnosing and treating ADHD using the ICD-10 framework.