ICD-10: Attention-Deficit Hyperactivity Disorder, Predominantly Inattentive Type

What Are ICD-10 Codes?

A little more than 125 years ago, doctors came together to create the first International Classification of Diseases. It was the first time that anyone had ever attempted to publish a list of every known disease along with treatments and other information about them. Today, the latest version is ICD-11, but that version is not yet fully adopted worldwide. Therefore, ICD-10 is, by and large, still the version of the list that is in effect. The number in the title indicates the 10th revision of the original.

The gist of the list is that each disease is described and then classified by a code. Each code also has a series of other codes listed beneath it. Each of these additional codes is a subcategory of the disease described under the primary code. As an example, if the main code covers COVID-19, then the subcategories could cover the delta variant and omicron variant, with future codes covering additional mutations of the original virus. The list also contains treatment options, a list of symptoms, possible prognoses, and other data that applies to each condition or any of its variants.

The goal of the list is not only to keep track of diseases and their spread throughout the world but also to be a reference work for both medical professionals and health insurance companies. As any disease affects the current population, doctors and researchers can gather data and then apply what they’ve learned to the modification and improvement of different treatment options.

Because diseases mutate, it’s crucial for medical professionals to have the very latest information about any previous version of a disease. For example, measles itself has the code B05. If it’s complicated by otitis media, then that’s B05.3. In the future, if there is another disease that reacts badly with measles, then knowing all about measles and its previous complications will be invaluable when devising new treatments for the latest problem.

When these new treatments come into being, they must be evaluated for effectiveness and safety. When researchers have determined these treatments to be safe and effective, the applicable information learned will become an update to the current list. The same holds true for side effects.

When it comes to comorbid conditions, such as measles interacting with encephalitis, otitis media, or other conditions, it’s important to know how these interactions affect people and the actual spread of the diseases involved. These comorbid conditions are usually assigned their own subcategory under the heading of the primary disease in question. It is possible for existing treatments to be contraindicated in the treatment of either condition or even both conditions. The list then helps doctors to realize the problem and to come up with new treatment options.

Health insurance companies rely on the ICD-10 list to bill correctly for treatments related to the diseases in the list. Because the American system is so complex, it helps quite a bit to have such a collated and comprehensive list. After all, billing issues create problems for the people waiting for coverage to get their treatments. The companies can also use the information in the list, together with their own reports on the diseases and conditions for which their clients received coverage for treatment, to forecast their future when it comes to earnings, trends, and overall outlook.

ICD-10 Code F90.0: Attention-Deficit Hyperactivity Disorder, Predominantly Inattentive Type

F90 is a not billable code on the ICD-10 list, but F90.0 is, along with all its subcategories. As with other billable codes on the list, it’s generally exclusive to the United States. Internationally, these codes may be billable or not. There are other codes for different versions of ADHD, such as predominantly hyperactive, hyperactive, impulsive, and inattentive. Each of these codes is a subcategory. Despite similarities in symptoms, the F90 series of codes excludes anxiety and mood disorders as well as developmental disorders.

ADHD, Predominantly Inattentive Type, Itself

ADHD is an example of a neurodivergent condition. That means that people who experience ADHD process information in their brains in a different manner than neurotypical people. Generally, people with ADHD can experience sensory overload at the same time as being disorganized. They’ll often fixate on one topic at a time but switch topics at a rapid rate. Many times, people who experience the predominantly inattentive version of ADHD, or the actual inattentive version, will forget to return phone calls, miss appointments, and even not pay bills on time, despite their good intentions. 

People who experience ADHD have described the condition as having a great number of tabs open at once and trying to deal with all of them at the same time. Others have said that it’s like having a radio on scan that plays only four seconds of each song before moving to the next. The people experiencing the inattentive types of ADHD also forget the content of “tabs” they’ve just seen. One common example is reading the directions about how to make boxed macaroni and cheese, tossing the empty box in the trash, and then retrieving it because they forgot what they read mere seconds before.

The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) lists the criteria someone must exhibit before receiving a diagnosis of the inattentive version of ADHD. These include:

  • Failing to pay close attention to details
  • Making careless mistakes
  • Not staying focused on work or even leisure activities
  • Seemingly not listening to conversations and/or daydreaming
  • Failing to finish tasks
  • Failing to follow instructions
  • Having trouble organizing
  • Disliking tasks that require concentration over long periods
  • Losing things required for work or leisure activities
  • Becoming easily distracted
  • Forgetting things

In children 16 years of age or younger, exhibiting six or more of these symptoms is indicative of ADHD. In 17-year-olds and adults, it’s five or more of these symptoms. Additionally, all four of the following criteria must apply:

  • The symptoms must have been present since before the age of 12.
  • The symptoms must be present in more than one setting, such as school, work, and leisure activities.
  • The symptoms must interfere with the person’s ability to function in school, at work, or in social situations.
  • The symptoms must not be associated with a different mental health condition or disorder, such as depressive disorder, bipolar disorder, or similar conditions.

In all cases, the symptoms must have been both continually present and causing difficulties for at least six months in situations where attention is required.

According to information from the Cleveland Clinic, no one knows for sure what causes ADHD of any type. There is a possible genetic link because the condition often appears in different generations of the same family. Many people who discover that they have the condition when they are adults, particularly those who have the inattentive version without the impulsivity or hyperactivity subcategories, go undiagnosed as children and adolescents. More often than not, they are merely considered lazy, uncaring, or simply “daydreamers.” 

Girls who are expected to be passive, quiet, and polite often “suffer in silence” when something as simple as proper observation of behavior could lead to a correct diagnosis and treatment options. When it comes to women who experience the condition, it’s all too common for them never to receive a diagnosis until they have children of their own who receive a diagnosis of ADHD, inattentive or any other type.

There is also some research that suggests a connection between environment and ADHD. Environmental trauma that happens to an expectant mother, for example, such as exposure to certain toxins, could lead to ADHD in children. Women who use alcohol, tobacco, or both while pregnant could have children with a higher-than-average chance of developing ADHD. Other research suggests that even low birth weight might have an effect. None of this research is highly correlative, however, and further research is needed to be able to consider any of these causes as statistically significant.

The Cleveland Clinic notes that the treatment of ADHD includes the use of medication and/or therapy of one kind or another. The medications are mostly effective at treating the inattentive version of ADHD. Three classifications of medications are used: psychostimulants, antidepressants, and nonstimulants. 

The most common medications for the treatment of ADHD are psychostimulants. Usually, these prescriptions are for some form of amphetamine or methylphenidate. Adderall is the brand name of the most commonly prescribed amphetamine, and Ritalin is the brand name of the most commonly prescribed medication containing methylphenidate. Depending on the case, these medications could be extended release or immediate release, and your doctor will discuss with you which is better in your specific situation.

The use of Effexor, Wellbutrin, or other antidepressants and mood stabilizers for ADHD is not approved by the FDA in the same way as the psychostimulants are. However, many doctors prescribe these medications off-label. In cases where depressive disorder, bipolar disorder, or another such condition is comorbid with inattentive ADHD, the medication prescribed for the comorbid condition usually has a beneficial effect on the ADHD at the same time.

Generally, the use of nonstimulant medications is reserved for cases where the person is allergic to the psychostimulant or doesn’t tolerate it well. Sometimes, the drug is just ineffective. Strattera is the most common FDA-approved nonstimulant used for the treatment of ADHD.

The most common therapy used to treat ADHD is cognitive behavioral therapy (CBT). The person learns to recognize the signs and symptoms of ADHD, pause and “take a breath,” and implement strategies to counteract those signs and symptoms. Eye movement desensitization and reprocessing (EMDR) is useful in treating ADHD that is accompanied by comorbid conditions like anxiety or post-traumatic stress disorder (PTSD) because EMDR is useful in treating the comorbid conditions.

Why Accuracy Is Important

Receiving the right care for any condition requires accuracy. Doctors, of course, don’t want to misdiagnose a condition and prescribe the wrong medication, which can have serious consequences. Insurance companies don’t want to pay the wrong amount for coverage. In all cases, the ICD-10 list of conditions is a primary resource. Because the list is collaborative, numerous checks and balances are inherent in the process, leading to as much accuracy as possible.

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