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Adult Diagnosis & Treatment This forum is for the discussion of issues related to the diagnosis of AD/HD

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Old 11-22-17, 08:48 PM
DJ Bill DJ Bill is offline
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Unhappy Found out my doctor didn't put ADHD on my diagnosis.....problem!

I got diagnosed I guess a year or so ago.....(Don't ask me to keep track of time! Heck I sometimes write the wrong year by decades on checks!) Anyhow, my gp did the diagnosing, and prescribed Ritalin...

Fast forward to two weeks ago. I call in refills to all my meds, visit the doc so he can re-prescribe the generic methylphenidate, and stop in to the Walmart to pick them up a few days later.

I get told there is a problem with insurance, they need another preauthorization.....and My doc will talk with me about it two weeks from that time at my next appointment.

Long story short, finally got the scrip filled but now instead of three a day it is one 10 mg a day. After I get the methylphenidate from the pharmacy, I get a letter from the insurance company denying any further use of Ritalin, because I am not diagnosed with ADHD. Huh???

The Insurance code my doctor used on the paperwork is R41.840 - "attention and concentration deficit".

The one they want for ADHD is F90.x - 0, 1, 2, 8, 9 are the number x depending on which type.

Looking at the description of ADHD they give, it appears they are way behind the times....One thing the code site I visited said was the ADHD starts in early childhood, and a small minority of cases it continues into mid- adulthood. ( Nothing said about later adulthood??)

So.....whats the diff between and attention and concentration deficit and "real" ADHD?

And is dropping from 30 mg to 10 mg a day really a good idea???

I get to ask all these questions to the doc next Wednesday. Until then, any thoughts?
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Old 11-22-17, 08:53 PM
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Re: Found out my doctor didn't put ADHD on my diagnosis.....problem!

If you have enough, I would continue taking 30mgs per day as normal, then raise the issue with your doctor and demand it get sorted immediately.
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Old 11-23-17, 12:32 AM
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Re: Found out my doctor didn't put ADHD on my diagnosis.....problem!

I'd be interested, too, to know what a diagnosis of "attention and concentration deficit" is if it's not ADHD.

I recently logged into my account at the online "patient portal" where I was able to look at the prior authorization requests that my doctor has submitted to the insurance company for some of my medications. The one for my Vyvanse prescription said "Diagnosis: Attention-deficit hyperactivity disorder, combined type." He didn't use a code.
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Old 11-23-17, 06:41 AM
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Re: Found out my doctor didn't put ADHD on my diagnosis.....problem!

Quote:
Originally Posted by DJ Bill View Post
I got diagnosed I guess a year or so ago.....(Don't ask me to keep track of time! Heck I sometimes write the wrong year by decades on checks!) Anyhow, my gp did the diagnosing, and prescribed Ritalin...

Fast forward to two weeks ago. I call in refills to all my meds, visit the doc so he can re-prescribe the generic methylphenidate, and stop in to the Walmart to pick them up a few days later.

I get told there is a problem with insurance, they need another preauthorization.....and My doc will talk with me about it two weeks from that time at my next appointment.

Long story short, finally got the scrip filled but now instead of three a day it is one 10 mg a day. After I get the methylphenidate from the pharmacy, I get a letter from the insurance company denying any further use of Ritalin, because I am not diagnosed with ADHD. Huh???

The Insurance code my doctor used on the paperwork is R41.840 - "attention and concentration deficit".

The one they want for ADHD is F90.x - 0, 1, 2, 8, 9 are the number x depending on which type.

Looking at the description of ADHD they give, it appears they are way behind the times....One thing the code site I visited said was the ADHD starts in early childhood, and a small minority of cases it continues into mid- adulthood. ( Nothing said about later adulthood??)

So.....whats the diff between and attention and concentration deficit and "real" ADHD?

And is dropping from 30 mg to 10 mg a day really a good idea???

I get to ask all these questions to the doc next Wednesday. Until then, any thoughts?
Basically? Its money. Find out what code your insurance wants and march in there with that exact request.
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Old 11-23-17, 11:43 AM
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Re: Found out my doctor didn't put ADHD on my diagnosis.....problem!

Yup, Sarah - I intend to do that. I hope the doc already sent the appropriate code in and just made an oops on the refill instructions......the doc and his staff have been referring to my issues as ADD when they talk to me. (No, they aren't up on the latest DSM name for it..lol. )

Well, it is time to travel to Northern NJ for turkey dinner at my sisters.. Have a good Thanksgiving everyone!! (And yes, for the drive I will be following the previous dosing protocol! One 10mg. for the entire day isn't gonna do it for me on the NYS Thruway!)
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Old 11-23-17, 04:56 PM
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Re: Found out my doctor didn't put ADHD on my diagnosis.....problem!

Quote:
Originally Posted by PoppnNSailinMan View Post
I'd be interested, too, to know what a diagnosis of "attention and concentration deficit" is if it's not ADHD.
I think I found an answer to this question. One diagnostic coding site I was looking at said:

Quote:
R41.840 Attention and concentration deficit
R41.840 is a billable medical code.
Excludes
• attention-deficit hyperactivity disorders (F90.-)
So, it appears that this diagnostic code is used to diagnose attention and concentration deficits, but ones excluding ADHD. Your doctor obviously used the wrong code by mistake.
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Old 11-24-17, 12:48 AM
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Re: Found out my doctor didn't put ADHD on my diagnosis.....problem!

You might need to talk to the office manager.

The doctor doesn't put in that paperwork/coding ... it's the office manager.

And definitely tell her that you were cut off of medication support.
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