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ICD-10 codes for autistic people with lower support needs

A client on the autism spectrum will most commonly be diagnosed with a specifier code that provides detail about how their symptoms present.

Diagnosis codes for autism spectrum disorder are included in the ICD-10 under the section “Mental, Behavioral and Neurodevelopmental disorders.”

Autism exists on a spectrum, which means it can impact people’s lives to varying degrees. The term "high-functioning autism" was previously used but is now considered outdated, as functioning labels do not accurately reflect an individual’s strengths and challenges. Instead, some autistic people are described as having lower support needs, meaning they may require less assistance in daily life while still experiencing differences in communication, sensory processing, or other areas.

While medical terminology about autism includes the word “disorder,” it’s important to note that many autism organizations are moving away from pathologizing language. People with autism may not see autism as a disorder they have, but it is who they are.

Although it’s commonly associated with children, many adults also experience symptoms of autism; it can be diagnosed at any age. Autism diagnosis requires formal testing from a licensed and trained professional.

It’s important that you make a clear, accurate and specific diagnosis that is appropriate to your individual patient clinical picture. These examples should be for reference and are not intended to guide a diagnosis. The client must meet diagnostic criteria for the F code they are assigned.

What are the most common ICD codes for autism with low support needs?

A client exhibiting autistic traits will most commonly receive a diagnosis with one of the following specifier codes:

  • F84.0 Autistic disorder: Symptoms may include abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interest. Manifestations of the disorder vary greatly depending on the developmental level and chronological age of the individual.
  • F84.5 Aspberger’s syndrome: Symptoms may be the same as autistic disorder but with a milder presentation. (Note: Aspberger's has been consolidated into the umbrella "autism spectrum disorder" for DSM diagnosis and is no longer being used. However, it technically still is an ICD-10 diagnosis.)
  • Z13.41: A new ICD-10 code that describes an encounter for an autism screening. Some payers do not recognize Z-codes, so be sure to verify with the insurance provider before using this ICD-10 code.

How to find other ICD codes

The World Health Organization’s official ICD-10 manual is available online, where you can find a list of diagnosis codes associated with autism symptoms listed under Mental, Behavioral and Neurodevelopmental disorders (Pervasive developmental disorders). 

The ICD-10 Database is another source for detailed clinical information about each ICD-10 code. This database is maintained by AAPC, or the American Academy of Professional Coders.

Not all ICD-10 codes are accepted for insurance billing. Each insurance company typically has its own specific guidelines for claim submission, as well as lists of covered and non-covered codes. It's important that you stay up to date with the billing requirements of the insurance plans you’re credentialed with to ensure the codes you’re using are supported for reimbursement.

What is the ICD-10?

The ICD-10 is a coding system developed by the World Health Organization (WHO) for the classification of diseases and other health-related conditions. The alphanumeric codes in the ICD-10 are used by healthcare providers and insurance companies to represent disorders and other health conditions for the purpose of standardizing medical records and billing.

Its name, ICD-10, stands for the International Classification of Diseases 10th Edition; the 10th edition was endorsed in 1990 to replace the ICD-9, and fully adopted in the United States by October 1, 2015. The ICD-11 has been published by WHO, but has yet to be adopted in the US.

How is ICD-10 different from DSM-5? 

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and the ICD (International Classification of Diseases, Tenth Revision) are both classification systems used in the diagnosis of mental health disorders, but they have different origins, purposes, and scopes.

The DSM-5 is published by the American Psychiatric Association (APA), is used primarily in the United States, and focuses exclusively on mental disorders. The ICD-10 is published by the World Health Organization (WHO), is used worldwide, and covers all health-related issues, not just mental disorders.

The DSM-5 is compatible with the ICD-10 coding system now in use by many insurance companies. Because it has a narrower scope, the DSM-5 includes more detail about the diagnostic criteria for mental disorders. The criteria included in the DSM-5 can be used to diagnose mental health disorders, and documentation should demonstrate the support of this diagnostic criteria.

This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.

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