Diagnosis of autism involves the comparison of an individual’s symptoms with autism spectrum diagnosis codes, the two official sources being the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

Autism is typically identified through social and non-social characteristics. But how they are used to diagnose depends on the diagnostic system used. 

In this post, we are going to discuss the autism spectrum diagnosis codes you have probably heard from your child’s developmental pediatrician or therapist - DSM-5 and ICD-10 codes for autism. We’re taking a closer look at each - what they tell us, their differences, and the importance of the diagnosis code.

ICD-10 Code for Autism

The International Classification of Diseases - Tenth Revision, or simply ICD-10, is a system recognized worldwide and used for classifying and coding different health conditions, including Autism Spectrum Disorder. Autism is classified in the ICD-10-CM Index and has the code F84.0, under the section of Mental and Behavioral Disorders and the Classification Pervasive Developmental Disorders under Disorders of Psychological Development. 

In the ICD-10 System, as mentioned, autism bears the code F84.0, but there are other related codes for related conditions - F84.1 for Atypical Autism, F84.5 for Asperger’s Syndrome, and F84.9 for Pervasive Developmental Disorders Not Otherwise Specified. 

Childhood Autism (F84.0)

This subtype refers to the classic form of autism characterized by early onset and recognizable impairments in communication, social interaction, and evident restricted and repetitive patterns of behavior.

Atypical Autism (F84.1)

This subtype is for individuals who do not meet all the criteria for childhood autism but with evident similar impairments in social communication and/or behavior.

Asperger’s Syndrome (F84.5)

Asperger’s Syndrome is characterized by milder social impairments, restricted interests, and repetitive behaviors compared to those diagnosed with childhood autism.

Pervasive Developmental Disorders Not Otherwise Specified (F84.9)

This subtype includes individuals exhibiting some but not all of the required characteristics to be given a specific diagnosis within the autism spectrum.

These codes ensure that a precise diagnosis is given to individuals and that they will later on receive the appropriate support and resources. Additionally, these codes are used in insurance coverage and reimbursement, and they’re required by insurance companies whenever a member claims for autism-related treatment or service.

DSM-5 Criteria for Autism

The Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition or DSM-5, is what’s used by most mental health professionals in the United States. In 2013, the DSM-5 stated that for a diagnosis of autism to be given to an individual, persistent deficits in different contexts of communication and social interaction should be evident, like in nonverbal communicative behaviors applied for social interaction, in social-emotional reciprocity, and in developing, keeping, and understanding relationships with others.

Additionally, symptoms for ASD must manifest since the individual’s early developmental period, though they may not be fully evident until certain social demands surpass their limited capacities or they may be masked by some learned strategies. These symptoms must result in clinically significant impairment in occupational and social aspects of the individual, among others.

DSM-5 Severity Levels

ASD is called a spectrum for a reason - it’s not one-size-fits-all. Different individuals with autism are affected in varying ways and degrees. In the DSM-5 medical coding for autism, there are three severity levels for ASD: 

• Level 3, which needs very substantial support
• Level 2, which needs substantial support
• Level 1, which needs support

Determining the right severity level is crucial in delivering the appropriate support, care, and intervention strategies that the person with ASD will need.

Importance of Autism Spectrum Diagnosis Codes

Diagnosis Codes matter because they’re used by healthcare professionals to determine and classify an autism diagnosis. Here are a few other reasons why medical coding for autism is important.

For Awareness

The autism diagnosis code is a tool in raising awareness about the prevalence of autism spectrum disorder today and its impact on the lives of individuals on the spectrum and society. It also encourages advocacy efforts, fund allocations from the government, and policy changes that can better the lives of people with ASD and their families.

For Access to Various Programs and Services

The autism diagnosis code is often necessary to get access to certain support programs and to be eligible for some interventions and financial assistance. 

For Research

Another reason the autism diagnosis code is important is that, through it, researchers are able to analyze data from different studies. This results in a better understanding of autism and the development of interventions that can help.

For Insurance Coverage

Most insurance plans require the autism diagnosis code when providing coverage for anything autism-related, including medications, therapies, and treatments.

Understanding DSM-5 or the ICD-10 code for autism (depending on where you’re at) helps parents navigate the healthcare system, ensuring that they’re getting the support their child needs and deserves. 

How to Obtain an Autism Spectrum Diagnosis Code

For you to obtain the autism diagnosis code, you’d need a comprehensive evaluation by a healthcare professional who specializes in ASD. The evaluation involves different assessments and activities that will help determine if the individual indeed meets the ICD-10 or DSM-5 criteria for autism diagnosis. Once that’s confirmed, the healthcare professional will then assign a specific code to officially give the diagnosis of autism.

Knowing About DSM-5 and ICD-10 Is Key to Getting the Right Interventions

DSM-5 and ICD-10 codes for autism are two classification systems that are used to diagnose mental health conditions, including ASD. They have similarities, but there are also differences in how they diagnose and classify autism. The bottom line is that having the right diagnosis ensures that individuals with autism get the appropriate care and support that they need from centers like Aluma Care.

Aluma Care is dedicated to providing tailored ABA therapy services to individuals with autism in Kansas. Reach out to us to schedule a consultation! 

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