Billing and Coding for Fetal Alcohol Spectrum Disorders

Accurate coding is essential to proper payment and continued service. Alcohol is a teratogen with global effects on the developing brain, and children with an FASD typically present with a broad spectrum of multiple physical, behavioral, neurocognitive, and mental health conditions. Like other children with special health care needs, children with an FASD require extra time and effort from their medical home over the course of their youth.

The ICD-10-CM developed coding options for Fetal Alcohol Spectrum Disorders with categories that include primary diagnoses, facial features, development, physical and neurodevelopmental abnormalities, secondary diagnoses, medical home practice services, and auxiliary services. The coding fact sheets cover the multiple types of physical, behavioral, neurocognitive and mental health symptoms presented by individuals with an FASD.

Evaluation and Management (E/M) codes help the practitioner document the time spent in the various aspects of patient treatment. Accurate ICD-10-CM and E/M codes are essential to obtaining proper payment. Learn how to code within the specific guidelines of your practice.

Coding Fact Sheets

The AAP provides coding fact sheets that outline the various codes for patient visits. Some links to useful sheets are listed below. The Academy can also provide direct support. Contact the AAP coding hotline with questions and billing challenges. Have coding questions? Contact the coding hotline.

• Fetal Alcohol Spectrum Disorders
• Attention Deficit Hyperactivity Disorder
• Developmental screening/testing and emotional and behavioral assessments 
• Substance Use/Abuse 
• Trauma
• Understanding Adolescent Confidentiality as it Relates to Billing

Practice Transformation—Receiving Payment for Services

Review the AAP Practice Transformation pages to advocate for appropriate payment. The portal includes resources on value-based payment methodologies including accountable care organizations (ACOs) and alternative payment models (APMs).