CDI Tips: Intellectual Disability

Topic: Intellectual Disability

Definition: Intellectual disability, formerly known as mental retardation, characterized by:

  • Impairment of intellectual function (IQ< 70)
  • Associated with adaptive behavior problems
  • Begins prior to age 18
  • Disrupts abilities necessary for independent living
  • Lifelong condition where many will need some degree of assistance throughout their lives

Diagnostic Criteria:

  • Diagnosing intellectual disability is a process that takes multiple steps:
  • IQ testing- usually severity is not conclusive until child is older
  • Assessing adaptive behavior capabilities
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Coding Considerations:

  • Mental retardation is indexed as intellectual disability.
  • Severity and/or the associated IQ should be documented, which are recognized as CC’s and SOI of 2 status.
  • The underlying cause of the intellectual disability should be documented and coded.
  • Other intellectual disabilities in ICD-10-CM include: F78.A1 SYNGAP1-related intellectual disability and F78.A9 Other genetic related intellectual disability. Code also associated conditions such as autism, encephalopathy, epilepsy, etc.
  • AHA Coding Clinic, Fourth Quarter 2019, p.14
    • Prader-Willi syndrome (PWS) is a complex neurodevelopmental disorder that affects many parts of the body. It is caused by lack of expression of genes in the paternally inherited chromosome 15q11.2-q13. During infancy, PWS is characterized by hypotonia, feeding difficulties, poor growth, and delayed development. Beginning in childhood, affected individuals develop an insatiable appetite, which leads to chronic overeating (hyperphagia) and obesity. PWS is the most common genetic syndrome causing obesity. Some people with PWS, particularly those with obesity, also develop type 2 diabetes.
    • Code 87.9 was expanded to provide a unique code for Prader-Will Syndrome which is Q87.11.

CDI Practice Considerations:

  • Be alert for the following causes of intellectual disability and query as needed. Some include, but are not limited to:
    • Down’s syndrome
    • Cerebral palsy
    • Autism
    • Birth defects
    • Fetal alcohol syndrome
    • Infection
    • Head trauma during birth or early childhood
    • Hypoxia during birth
    • Premature birth
    • Drugs, poisons, and toxins that disrupt fetal development
  • Many patients with autism and cerebral palsy do not have intellectual disability.
  • If provider does not state severity of the intellectual disability, there may be an opportunity to query for severity. Look for supporting documentation of the disability such as ADLs assistance, social assistance needed, language/literacy issues. Potential comorbidities for patients that have severe intellectual disability which may be query opportunities:
    • Functional quadriplegia
    • Pressure ulcers
    • Aspiration pneumonia

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