ICD-10 Coding for Autism(F84.0, F84.5)
Complete ICD-10-CM coding and documentation guide for Autism. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Autism
F84Primary Range
Pervasive developmental disorders
This range includes all codes related to autism and related developmental disorders.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F84.0 | Autistic disorder | Use when the patient meets DSM-5 criteria for autism spectrum disorder. |
|
| F84.5 | Asperger's syndrome | Use for historical diagnoses made before DSM-5. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for autism
Essential facts and insights about Autism
Primary ICD-10-CM Codes for autism
Decision Criteria
clinical Criteria
- Patient exhibits at least six symptoms from DSM-5 criteria.
documentation Criteria
- Detailed description of social and communication deficits.
Clinical Validation Requirements
- Persistent deficits in social communication and interaction
- Restricted, repetitive patterns of behavior
- Symptoms present in early developmental period
Code-Specific Risks
- Misdiagnosis if criteria are not thoroughly documented
- Incorrect sequencing with comorbid conditions
Coding Notes
- Ensure documentation includes specific DSM-5 criteria and developmental history.
F84.5 - Asperger's syndrome
Use for historical diagnoses made before DSM-5.
Applicable To
- Asperger's disorder
Excludes
- Autistic disorder (F84.0)
Clinical Validation Requirements
- No significant delay in language or cognitive development
- Impairment in social interaction
Coding Notes
Use only for diagnoses made prior to DSM-5 implementation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Autism to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F84.0.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Claim denials due to lack of supporting documentation.
Mitigation Strategy
Regular training on DSM-5 criteria, Use of documentation templates
Impact
Reimbursement: Potential claim denials due to incorrect coding., Compliance: Non-compliance with current DSM-5 guidelines., Data Quality: Inaccurate data reporting and tracking.
Mitigation Strategy
Use F84.0 for all new autism spectrum disorder diagnoses.
Impact
Incorrect sequencing of F84.0 with comorbid conditions.
Mitigation Strategy
Follow payer-specific guidelines for code sequencing.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Autism, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Autism
Use these documentation templates to ensure complete and accurate documentation for Autism. These templates include all required elements for proper coding and billing.
Initial Autism Diagnosis
Specialty: PediatricsRequired Elements
- Social communication deficits
- Repetitive behaviors
- Developmental history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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