ICD-10 Coding for Behavior Problem(F91.1, F90.1)
Complete ICD-10-CM coding and documentation guide for Behavior Problem. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Behavior Problem
F90-F98Primary Range
Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
This range includes primary codes for common behavioral disorders such as ADHD and conduct disorders.
Symptoms and signs involving emotional state and behavior
This range includes codes for symptoms like irritability and slowness, which may be used as ancillary codes.
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 criteria for conduct disorder are met, including aggressive behavior and rule violations. |
|
| F90.1 | Attention-deficit hyperactivity disorder, predominantly inattentive type | Use when inattention symptoms are predominant and meet DSM-5 criteria. |
|
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 conduct disorder
Essential facts and insights about Behavior Problem
Primary ICD-10-CM Codes for behavior problem
Decision Criteria
clinical Criteria
- Presence of aggressive behavior and rule violations
Applicable To
- Recurrent physical cruelty
- Theft
- Violation of rules
Excludes
- Oppositional defiant disorder (F91.3)
Clinical Validation Requirements
- Documented episodes of aggression or theft
- School suspensions for fighting
Code-Specific Risks
- Misclassification with oppositional defiant disorder
Coding Notes
- Ensure documentation specifies aggressive acts and rule violations.
F90.1 - Attention-deficit hyperactivity disorder, predominantly inattentive type
Use when inattention symptoms are predominant and meet DSM-5 criteria.
Applicable To
- Inattention symptoms persisting for more than 6 months
Excludes
- Hyperactivity without inattention (F90.0)
Clinical Validation Requirements
- Vanderbilt Scale indicating inattention
- Symptoms documented over 6 months
Coding Notes
Ensure detailed documentation of inattention symptoms.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Irritability and anger
R45.4Differential 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 Problem to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F91.1.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Increases risk of audit findings., Financial: Potential for claim denials.
Mitigation Strategy
Provide specific examples of aggressive acts., Link behavior to DSM-5 criteria.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Increases risk of non-compliance with coding guidelines., Data Quality: Reduces accuracy of health data.
Mitigation Strategy
Use specific codes such as F41.1 for generalized anxiety disorder when criteria are met.
Impact
High use of unspecified codes increases audit risk.
Mitigation Strategy
Use specific codes and ensure documentation supports code selection.
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 Problem, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Behavior Problem
Use these documentation templates to ensure complete and accurate documentation for Behavior Problem. These templates include all required elements for proper coding and billing.
Behavioral Health Initial Assessment
Specialty: PsychiatryRequired Elements
- Onset and duration of symptoms
- Specific behavioral episodes
- Impact on daily functioning
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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