Nearly everyone who works in positions related to healthcare is at least aware of the ICD-10 code system. This international system created by the World Health Organization is a comprehensive list of alphanumeric codes that cover thousands of different medical conditions, and over a hundred nations use it to classify information about mortality and the spread and prevalence of various afflictions. In your work, you may diagnose clients with specific conditions and then look up the corresponding ICD-10 code. Without that code, their insurance is unlikely to cover treatment, you won’t get reimbursed, and aftercare providers might not know what to do. “Other intellectual disabilities” is one particular code you might need to use.
Other Intellectual Disabilities
The ICD-10 code for other intellectual disabilities is F78. This code is one you might use when you diagnose a client as having an intellectual disability, but the diagnosis doesn’t fall into other closely related codes. Individuals categorized under this code might be nonverbal, suffer hearing loss, or have a form of physical impairment or disability. These factors can keep healthcare professionals from going through the screening tests that normally screen for specific intellectual disabilities. Depending on the specific diagnosis, intellectual disabilities can have many different potential codes.
Subcodes Under F78
There is an F78.A subgroup in the ICD-10 code list for other genetic-related intellectual disabilities. The World Health Organization classifies these under the broader mental, behavioral, and neurodevelopmental disorders. Two specific codes related to children fall under this umbrella.
The code F78.A stands for “SYNGAP1-related intellectual disability” cases. SYNGAP1 is a gene in the human body, and mutations or pathogenic variants can result in a spectrum of different neurodevelopmental disorders. These might include developmental delays, childhood-onset epilepsy, movement disorders, and autism spectrum disorder features. Potential symptoms and severities of this disorder can be drastically different from one person to the next. Children with SYNGAP1-related disorders have delays in attaining developmental milestones in their early years, and seizures are commonly the first symptom. The age of onset can range from the first few months of life to late childhood. It is important to note that, though extremely rare, some people with these disorders never actually develop epilepsy.
In some cases, a client might have a genetic-related intellectual disability that’s not specifically a SYNGAP1-related disorder. In such cases, you’ll probably diagnose them with the ICD-10 code F78.A9 for “other genetic-related intellectual disability” when creating your clinical notes.
F70: Mild Intellectual Disabilities
Individuals with a mild intellectual disability typically have an IQ in the range of 50 to 69 and demonstrate social immaturity. They take longer than expected when they learn how to talk, but they can communicate effectively once they do learn. Issues with reading and writing are likely to persist, but they can take advantage of specialized education plans to compensate. People with this level of intellectual disability often become independent in terms of self-care as they get older, but they struggle with the responsibilities involved with parenting and marriage.
F71: Moderate Intellectual Disabilities
People who have a moderate intellectual disability have IQs ranging from 35 to 49. They’re slow to understand language and use it, and that will manifest as many different kinds of communication disabilities. Still, these individuals can learn basic skills regarding counting, reading, and writing. As adults, they can rarely live alone, but they might be able to participate in social activities and get to familiar places on their own.
F72: Severe Intellectual Disabilities
Someone with a severe intellectual disability is likely to have an IQ ranging from 20 to 34. Motor impairment is noticeable. There is often severely abnormal development or damage to their central nervous system.
F73: Profound Intellectual Disabilities
If you have a client with a a profound intellectual disability, then their IQ is under 20. These individuals are incapable of independent self-care, and they require continuous supervision and help. Communication is nonverbal and extremely basic, and they can’t understand or comply with instructions and requests. Incontinence and immobility are common in these individuals.
F79: Unspecified Intellectual Disabilities
The final ICD-10 code related to cases such as these is F79 for unspecified intellectual disabilities. These are intelligence impairments individuals might develop due to disease, birth complications, or trauma. Unspecified cases of intellectual disabilities require several criteria for diagnosis. First, the client should be age five or older. Second, standardized testing can’t be finished because of mental health, behavioral, motor, or physical factors, even when clinicians suspect an intellectual disability. Formal diagnosis requires re-evaluation to confirm. Unspecified cases show the symptoms common to intellectual disability, but healthcare professionals can’t gather sufficient information to ascertain the actual level or severity of the disorder.
What Is an Intellectual Disability Disorder?
As you can see by the various codes, there are multiple types of intellectual disability. Also known as ID, this is the most frequently diagnosed form of developmental disability. The commonalities include certain limitations in cognitive skills and functioning. Impairments are frequently seen in self-care, social, language, practical, and conceptual skills. Individuals with these limitations develop more slowly than their peers, and their learning track might take different paths. Intellectual disabilities might occur while still in the womb or during the first two decades of life.
Before you can assign a specific ICD-10 code to clients for their particular intellectual disability, you need to first ensure they have an ID in general. Three criteria are listed for this to happen, and all three must be met:
- The condition has to manifest itself before they turn 22.
- Their IQ must be under 70.
- There need to be substantial limitations to their adaptive behavior in at least one area, and the possibilities include practical, social, and conceptual skills necessary for work, life, and play within a community.
Causes of Intellectual Disability
Intellectual disabilities used to be called mental retardation, but the causes haven’t changed. Disease, injury, or brain complications are common sources of this condition. In many cases, the cause is unknown. Pre-birth causes can include infections, congenital disabilities, Fragile X syndrome, Fetal Alcohol Syndrome, and Down Syndrome, but some of these can also happen shortly after birth. Other potential causes might not happen until later in life, and they can be stroke, infections, or severe head injury. Complications during birth and labor can also cause intellectual disabilities if a baby doesn’t get enough oxygen. Intellectual disabilities aren’t contagious, nor are they considered a mental illness.
Intellectual disability has no cure, and it is considered a lifelong condition. However, many people diagnosed with this disability can learn how to improve their personal functionality with time. Early and ongoing intervention helps these individuals thrive to the best of their abilities. Treatment for this condition should focus on the needs and strengths of the client in question, but there should also be an emphasis on extra conditions that might pertain to their case and recognition of their need for functional support. Proper diagnosis with the right ICD-10 code can unlock support services and rights that a client might be entitled to. These can range from special education to community and home services as provided by law where they live.
The many supportive services available for people with intellectual disabilities work best when there are early interventions that identify the specific kind and level of disability in young children, and that might happen during the infant and toddler stages. Federal law in the United States calls for free individual education plans, academic support, and special education for children with intellectual disabilities. Transition services after high school can help these people get ready for adulthood. Then, they might need housing options, day programs, and vocational assistance to learn skills or job roles. Individuals with intellectual disabilities of all ages might need psychiatric care, psychological services, therapy, rehabilitation, and assistive technology. They also commonly need services for audiology, language pathology, and speech skills.
In addition, individuals with intellectual disabilities might need a wide circle of support. In addition to caregivers, that should include family members, friends, professional colleagues, and community members. With the right treatment and support around them, many intellectually disabled people wind up providing contributions to their communities. Still, someone’s ability to cope with an intellectual disability and function is based on how severe the condition is. There are also frequently other underlying medical or genetic conditions that might impact their health and functionality.
ICD-10 Code Accuracy Is a Must
Proper diagnosis results in a specific ICD-10 code. Specific codes exist for various levels of severity in intellectual disability, but cases can fall under the F78 code for other intellectual disabilities where the cause or level might not be identifiable. The important thing is that you and other healthcare professionals diagnose the condition and assign a proper code as quickly as possible. These codes unlock health insurance coverage and even federal benefits that clients with intellectual disabilities are entitled to. In addition, without a code or the wrong one, your practice risks not getting reimbursed for the treatment provided. Also, families and other caregivers of intellectually disabled individuals can use these codes from your notes to look up more information about the conditions themselves so that they care for your clients to the best of their ability outside of your appointments and time with them.
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