Find comprehensive information on ADHD Combined Type, also known as Attention Deficit Hyperactivity Disorder Combined Type or ADHD-C. This resource offers guidance on clinical documentation, medical coding, and diagnostic criteria for Attention-Deficit/Hyperactivity Disorder, Combined Presentation, specifically for healthcare professionals. Learn about accurate diagnosis and effective treatment strategies for patients with ADHD Combined Type.
Also known as
ADHD, Combined Presentation
Attention-deficit/hyperactivity disorder, combined presentation.
Attention-Deficit/Hyperactivity Disorders
Covers various types of ADHD, including predominantly inattentive, hyperactive-impulsive, and combined.
Behavioural and Emotional Disorders
Includes disorders usually diagnosed in childhood and adolescence, such as ADHD and conduct disorders.
Mental, Behavioural, and Neurodev
Encompasses a wide range of mental and behavioural disorders, including neurodevelopmental disorders like ADHD.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the diagnosis ADHD Combined Type?
Yes
Is it predominantly inattentive?
No
Do not code F90.0. Review clinical documentation for alternative diagnosis.
When to use each related code
| Description |
|---|
| Inattention, hyperactivity, and impulsivity significantly impact daily life. |
| Predominantly inattentive, difficulty focusing, easily distracted, but not hyperactive. |
| Predominantly hyperactive-impulsive; excessive movement, impulsivity, but not inattentive. |
Inaccurate coding if ADHD diagnosis is applied outside typical age range, impacting medical necessity reviews and reimbursement.
Lack of specific symptoms, impairment details, and diagnostic criteria in the medical record can lead to coding errors and denials.
Miscoding or overlooking co-existing conditions like anxiety or learning disabilities with ADHD can affect treatment and resource allocation.
Q: How can I differentiate between ADHD Combined Type and other presentations of ADHD in clinical practice using evidence-based diagnostic criteria?
A: Differentiating ADHD Combined Type (ADHD-C) from Predominantly Inattentive Presentation (ADHD-PI) and Predominantly Hyperactive-Impulsive Presentation (ADHD-HI) requires careful assessment based on DSM-5 criteria. ADHD-C is diagnosed when the individual meets the symptom criteria for both inattention and hyperactivity-impulsivity. Specifically, six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity must be present for at least six months, and these symptoms must be present before age 12 and impact functioning in at least two settings. Crucially, explore the specific manifestations of these symptoms. While individuals with ADHD-PI may present with difficulty sustaining attention, those with ADHD-C experience this alongside excessive motor activity, impulsivity, and difficulty regulating behavior. Explore the developmental trajectory of symptoms and consider comorbidities. For a more comprehensive differential diagnosis process, explore how validated rating scales and behavioral observations can provide further insights. Consider implementing structured interviews that gather information from multiple sources, such as parents, teachers, and the individual themselves.
Q: What are the evidence-based best practices for managing comorbid conditions frequently associated with ADHD Combined Type in adolescents?
A: Adolescents with ADHD Combined Type (ADHD-C) often present with comorbid conditions such as Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), anxiety disorders, and learning disabilities. Effective management requires a multimodal approach addressing both ADHD and the comorbid condition(s). Evidence-based practices for ADHD-C typically include medication (stimulants or non-stimulants) combined with behavioral therapy, such as parent training, classroom management strategies, and social skills training. When ODD or CD is present, incorporate specific interventions that address defiance and aggression, like parent management training and cognitive behavioral therapy. For anxiety disorders, cognitive behavioral therapy and mindfulness-based techniques can be beneficial. Co-occurring learning disabilities require individualized educational support and accommodations. Integrated treatment plans addressing all presenting concerns are crucial. Learn more about the interplay between ADHD-C and specific comorbid conditions to tailor treatment strategies effectively and improve patient outcomes. Consider implementing a collaborative care model involving therapists, psychiatrists, educators, and families.
Patient presents with symptoms consistent with ADHD Combined Type (ADHD-C, Attention Deficit Hyperactivity Disorder Combined Type, Attention-Deficit/Hyperactivity Disorder, Combined Presentation). The patient exhibits both inattentive and hyperactive-impulsive symptoms meeting DSM-5 diagnostic criteria. Inattention manifests as difficulty sustaining focus, forgetfulness in daily activities, organizational challenges, and distractibility. Hyperactivity-impulsivity is observed through excessive talking, interrupting others, fidgeting, difficulty remaining seated, and impulsive behaviors. These symptoms are present in multiple settings (e.g., home, school, work) and have persisted for over six months, negatively impacting academic, occupational, and social functioning. Onset of symptoms was reported before age 12. Differential diagnosis considered other conditions including oppositional defiant disorder, anxiety disorders, and learning disabilities. Assessment included a clinical interview, behavioral rating scales completed by parents and teachers, and review of academic records. Treatment plan includes initiation of stimulant medication (methylphenidate) with titration based on symptom response and tolerability, parent training in behavior management techniques, and referral to educational support services to address academic challenges. Patient and family education provided regarding ADHD, medication management, and available community resources. Follow-up appointment scheduled in four weeks to monitor treatment efficacy and assess for any adverse effects. ICD-10 code F90.2 applied for ADHD Combined Presentation. CPT codes for evaluation and management services will be determined based on time spent with the patient and complexity of medical decision making.