Autism Diagnosis and ICD-10-CM

A recent report from US News was published regarding an October article in the Journal of the American Medical Association (JAMA) about the increase in autism.

The ICD-10-CM classification helps to aid in capturing this diagnosis which we know then drives the clinical data that is extremely valuable in understanding the frequency trends of this and other conditions.

The JAMA article shows that there are increases in new autism diagnoses among young adults, as well a rise in diagnoses for girls and young women. These increases have driven a near-tripling of U.S. autism cases in just over a decade, researchers report.

Data collected on more than 12 million patients enrolled in major U.S. health care systems found that between 2011 and 2022 the number of people diagnosed with autism climbed by 175 percent, according to a study published Oct. 30 in the journal JAMA Network Open.

The rise in diagnoses was especially dramatic among young adults ages 26 to 34 — this group experienced a 450percent increase (equivalent to more than a 5.5 times rise) in autism diagnoses between 2011 and 2022, the report found.

These facts made me want to learn more about Autism. I found some great information on the “Neurolaunch” website which states: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by persistent challenges in social communication and interaction, along with restricted and repetitive patterns of behavior, interests, or activities. The spectrum nature of autism means that individuals can present with a wide range of symptoms and severity levels, making accurate diagnosis both crucial and challenging.

Now turning to the ICD-10-CM, the system classifies “AUTISM” in Chapter 5 Mental, Behavioral and Neurodevelopmental disorders (F01-F99). When looking up the word “Autism” in the alphabetic index there are three entries which represents two code choices, F84.0 infantile and F84.9 atypical:

Autism, autistic (childhood) (infantile) F84.0

• atypical F84.9

• spectrum disorder F84.0

Going next to the tabular, we see F84 Pervasive developmental disorders and an instruction to 
“Code also any associated medical condition and intellectual disabilities.”

Then under the specific code F84.0 we will see the following:
F84.0 Autistic disorder

• Autism spectrum disorder
• Infantile autism
• Infantile psychosis
• Kanner’s syndrome

Excludes1: Asperger’s syndrome (F84.5)

Also in the tabular the code F84.9 Pervasive developmental disorder, unspecified. There is an inclusion term of:
Atypical autism

There are many synonyms or lay terms that might be used by providers when documenting the condition, so read over carefully the documentation as well as the signs/symptoms that the patient is demonstrating before assigning the correct diagnosis code.  If there is conflicting, contrasting, limited, missing documentation or even a diagnosis without supporting clinical indicators the coding and/or clinical documentation integrity specialists (CDISs) should query the provider. When querying, remember to utilize and follow the AHIMA/ACDIS Practice Brief on compliant querying.

The ICD-10-CM descriptions and category indicates the varying manifestations of autism. Remember always that the health record documentation and accurate medical coding creates more precise data, treatment planning, and even aides in research.

I know HIM and CDISs enjoy learning more about diagnoses, so I hope this short article was helpful. There is additional information within the website “Neurolaunch” which I would recommend reading over.  Also to learn more about autism spectrum disorders go to Autism Speaks. 

ICD-10-CM drives clinical data and is thus a wonderful component to the current and future diagnosing and treatment of many conditions.

Programming note:

Listen to Gloryanne Bryant as she reports this story live today on Talk Ten Tuesday, 10 Eastern, with Chuck Buck and Dr. Erica Remer.