F90.1 — ADHD, Predominantly Hyperactive-Impulsive

Clinical Description

F90.1 applies to ADHD presentations dominated by hyperactivity and impulsivity without clinically significant inattention. This presentation is less common in adults and more frequently diagnosed in younger children. Documentation should focus on hyperactive-impulsive behaviors.

Key Symptoms to Document

When using F90.1, your documentation should reference these symptoms:

• Fidgeting, squirming, or inability to remain seated when expected
• Running or climbing in inappropriate situations (or subjective restlessness in adults)
• Difficulty engaging in activities quietly
• Talking excessively
• Blurting out answers before questions are completed
• Difficulty waiting one's turn; frequently interrupting others

Common Interventions to Document

Evidence-based interventions typically documented with this diagnosis:

• Stimulant medication (methylphenidate, mixed amphetamine salts)
• Behavioral parent training (for children)
• Classroom or workplace accommodations
• Non-stimulant pharmacotherapy (atomoxetine, guanfacine ER)
• CBT for impulse control and self-regulation

CPT Code Pairings

Common CPT codes used when billing with F90.1:

• 90791 — Psychiatric diagnostic evaluation
• 99214 — Office visit, moderate complexity (medication management)
• 90834 — Individual psychotherapy, 45 minutes
• 96127 — Brief emotional/behavioral assessment
• 90847 — Family psychotherapy with patient present

Documentation Tips

• Document at least 6 hyperactive-impulsive symptoms (5 for age 17+) with concrete behavioral examples.
• Note that fewer than 6 inattentive symptoms are present to justify the predominantly hyperactive-impulsive specifier.
• Record observations of hyperactivity/impulsivity in the clinical setting and across other environments.
• Document symptom onset prior to age 12 and rule out medical causes (e.g., hyperthyroidism, medication side effects).
• Consider developmental appropriateness — behaviors must exceed what is typical for the patient's age.

Differential Diagnosis Considerations

When documenting F90.1, consider and rule out:

• ADHD, combined type (F90.2)
• Oppositional defiant disorder (F91.3)
• Bipolar disorder, manic or hypomanic episode (F31.x)
• Anxiety disorders (F41.x)
• Autism spectrum disorder (F84.0)
• Hyperthyroidism or medication side effects

Screening Tools

Standardized measures commonly used with this diagnosis:

• ASRS v1.1 (Adult ADHD Self-Report Scale)
• Vanderbilt ADHD Diagnostic Rating Scale
• Conners Rating Scales (parent, teacher, self-report)
• SNAP-IV