ICD-10 Coding for Behavior Concerns(F91.1, F90.1)
Complete ICD-10-CM coding and documentation guide for Behavior Concerns. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Behavior Concerns
F90-F98Primary Range
Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
This range includes codes for various behavioral disorders, including ADHD and conduct disorders, which are primary concerns in behavior issues.
Persons with potential health hazards related to socioeconomic and psychosocial circumstances
These codes are used to capture psychosocial factors that may influence behavior concerns, such as educational and economic issues.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F91.1 | Conduct disorder, childhood-onset type | Use when the patient exhibits persistent aggression and rule-breaking behaviors starting before age 10. |
|
| F90.1 | Attention-deficit hyperactivity disorder, predominantly hyperactive-impulsive type | Use when the patient shows ≥6 hyperactive/impulsive symptoms impairing function. |
|
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 behavior concerns
Essential facts and insights about Behavior Concerns
Primary ICD-10-CM Codes for behavior concern
Decision Criteria
clinical Criteria
- Presence of aggressive behaviors in multiple settings
documentation Criteria
- Detailed description of specific aggressive acts
Applicable To
- Persistent aggression
- Violation of others' rights
Excludes
- Oppositional defiant disorder (F91.3)
Clinical Validation Requirements
- Document ≥3 aggressive behaviors in 12 months
- Include specific acts like bullying or property destruction
Code-Specific Risks
- Overuse of unspecified codes
- Incorrect sequencing with underlying conditions
Coding Notes
- Ensure documentation specifies the frequency and context of behaviors.
F90.1 - Attention-deficit hyperactivity disorder, predominantly hyperactive-impulsive type
Use when the patient shows ≥6 hyperactive/impulsive symptoms impairing function.
Applicable To
- Hyperactivity
- Impulsivity
Excludes
- Conduct disorder (F91.-)
Clinical Validation Requirements
- Vanderbilt ADHD Rating Scale scores
- Symptoms present in ≥2 settings
Coding Notes
Ensure symptoms are documented across different settings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Food insecurity
Z59.41Differential 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 Behavior Concerns to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F91.1.
Impact
Clinical: Leads to misdiagnosis and inappropriate treatment., Regulatory: Increases risk of audit failures., Financial: May result in claim denials.
Mitigation Strategy
Use specific language detailing behaviors, Include corroborative evidence from multiple sources
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Increases risk of audits and compliance issues., Data Quality: Reduces accuracy of clinical data and reporting.
Mitigation Strategy
Use specific codes when clinical indicators like frequency and severity are documented.
Impact
High frequency of unspecified codes can trigger audits.
Mitigation Strategy
Use specific codes with detailed documentation.
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 Behavior Concerns, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Behavior Concerns
Use these documentation templates to ensure complete and accurate documentation for Behavior Concerns. These templates include all required elements for proper coding and billing.
Child with conduct disorder
Specialty: PediatricsRequired Elements
- Presenting Problem
- Behavioral Observations
- Functional Assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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