Autism Awareness Month: DSM-5 vs. ICD-10 Code for Autism

Autism Awareness Month: DSM-5 vs. ICD-10 Code for Autism

April is Autism Awareness Month, making it the perfect time to address one of the most significant challenges medical coders face when coding autism spectrum disorders: the misalignment between DSM-5 and ICD-10-CM. In this article, I’ll the disconnect and provide practical coding guidance for the most significant Social Determinants Of Health (SDOH) affecting autism patients.

The DSM-5 vs. ICD-10-CM Misalignment

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) approach autism spectrum disorders differently, creating coding challenges. Here’s an overview of how they classify these disorders:

DSM-5 Approach

• Single Diagnosis: The DSM-5 consolidated previously separate conditions into a single “autism spectrum disorder” diagnosis.
• Severity Levels: Uses severity levels 1-3 to indicate the level of support needed.
  • Level 1: “Requiring support”
  • Level 2: “Requiring substantial support”
  • Level 3: “Requiring very substantial support”
• Dimensions: Assesses deficits in social communication and restricted/repetitive behaviors separately.

ICD-10-CM Approach

• Multiple Codes: Maintains separate diagnostic codes for each type of disorder.
  • F84.0 Autistic disorder
  • F84.1 Atypical autism
  • F84.2 Rett’s syndrome
  • F84.3 Other childhood disintegrative disorder
  • F84.5 Asperger’s syndrome
  • F84.8 Other pervasive developmental disorders
  • F84.9 Pervasive developmental disorder, unspecified

Coding Solutions for DSM-5/ICD-10 Misalignment

1. When Provider Documents “Autism Spectrum Disorder”:
   • Primary Diagnosis: Currently codes to F84.0 per the ICD-10-CM tabular
2. Coding Former Diagnoses:
   • Asperger’s syndrome documentation → Code F84.5
   • Childhood disintegrative disorder → Code F84.3
   • PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified) → Code F84.9
3. Coding Co-occurring Conditions:
   • Always code intellectual disability separately (F70-F79)
   • Code language disorder separately (F80.1-F80.9)
   • Code ADHD separately (F90.0-F90.9)

Coding High-Impact Social Determinants for Autism Patients

Social Determinants of Health have recently become a significant item for coders to identify when reading charts. Properly documenting these factors supports medical necessity for treatments and services while providing a more complete clinical picture of the patient’s circumstances.

Some examples of Z codes to capture for autism patients could include:

• Z55.4: Educational maladjustment and discord with teachers/classmates
  • Example: When documentation mentions bullying at school or classroom behavioral incidents.
• Z55.8: Other problems related to education
  • Example: When IEP (Individualized Education Program) or special education services are noted.
• Z60.4: Social exclusion and rejection
  • Example: When documentation indicates difficulty making or maintaining friendships.
• Z62.6: Inappropriate parental pressure
  • Example: When parents have unrealistic expectations for child’s development.
• Z75.3: Unavailability of healthcare facilities
  • Example: When patient has limited access to autism specialists or therapies.

If your team still struggles with these coding challenges, our specialized coding support services are designed to help. By offering comprehensive training and practical guidance, we ensure that your coders are well-equipped to accurately document autism disorders and the associated Social Determinants of Health.

Let us partner with you to streamline your coding processes and improve patient outcomes. Fill out the form below to speak to one of our experts.