How to Document F90.0 in Therapy Notes: Best Practices for Clinicians
Mar 24, 2025
Approximately 7 million U.S. children between ages 3-17 receive an ADHD diagnosis. The F90.0 diagnosis code represents one of three ADHD subtypes. National parent surveys show that about 6 in 10 children with ADHD have moderate to severe symptoms. Accurate documentation plays a significant role in determining proper treatment.
The ICD-10 code F90.0 identifies predominantly inattentive ADHD. Medical providers need detailed diagnostic documentation and a full assessment from multiple settings. Your documentation quality directly affects insurance claim approvals and patient access to care. Proper documentation of diagnosis code F90.0 will give your patients the right treatment path while meeting clinical standards.
Let us walk you through the key components and best practices to document F90.0 in your therapy notes. This piece helps you create accurate clinical records that benefit both patient care and administrative needs.
Understanding the F90.0 Diagnosis Code in Clinical Context
Clinical diagnostic coding serves as the foundation of treatment planning and insurance reimbursement. The ICD-10 code F90.0 represents a specific classification within the broader ADHD spectrum that needs clinical precision for accurate documentation.
What F90.0 specifically represents in the ICD-10 framework
The F90.0 diagnosis code stands for "Attention-deficit hyperactivity disorder, predominantly inattentive type" in the ICD-10-CM classification system [1]. This billable code belongs to the broader category of mental, behavioral, and neurodevelopmental disorders (F01-F99). You'll find it in the section that covers behavioral and emotional disorders common in childhood and adolescence (F90-F98) [2].
Patients who show mainly inattentive symptoms without much hyperactivity or impulsivity receive the F90.0 code [3]. The code also appears under other names like "Attention deficit disorder," "ADHD, inattentive," or "ADHD, predominantly inattentive presentation" [1]. The current 2025 edition of ICD-10-CM F90.0 became effective on October 1, 2024 [1].
Clinical relevance: F90.0 targets treatment toward inattention-focused interventions rather than managing hyperactivity or impulsivity, unlike general ADHD codes.
Key symptoms of predominantly inattentive ADHD
Patients must show at least six of these nine symptoms of inattention to qualify for F90.0 diagnosis (children up to age 16) or five symptoms (if you have age 17 and older) [2]:
Often fails to give close attention to details or makes careless mistakes
Has difficulty sustaining attention in tasks or play activities
Does not seem to listen when spoken to directly
Does not follow through on instructions and fails to finish assigned tasks
Has difficulty organizing tasks and activities
Avoids, dislikes, or reluctantly involves in tasks requiring sustained mental effort
Loses items needed for tasks or activities
Is easily distracted by outside stimuli
Is forgetful in daily activities
These symptoms must last at least six months and appear in multiple settings (home, school, work). They should interfere by a lot with the patient's social, academic, or work life [4]. The symptoms must not match the person's developmental level [5].
How F90.0 is different from other ADHD diagnostic codes
The F90 category includes several specific ADHD coding options. The main difference lies in how symptoms show up and which ones dominate:
F90.0 (Predominantly inattentive type): Centers on inattention symptoms with minimal hyperactivity/impulsivity; people used to call it ADD [6]
F90.1 (Predominantly hyperactive type): Highlights hyperactive and impulsive symptoms with fewer attention issues [6]
F90.2 (Combined type): Shows both inattentive and hyperactive-impulsive signs [2]
F90.8 (Other type): Covers ADHD cases that don't fit standard categories [6]
F90.9 (Unspecified type): Applies when ADHD exists but the specific subtype remains unclear [6]
Research shows that doctors might miss predominantly inattentive ADHD (F90.0) cases, especially in girls who show fewer disruptive behaviors [7]. Around 2 to 3 in 10 people with ADHD struggle mainly with concentration and focus rather than hyperactivity or impulsiveness [7].
Doctors need to understand these differences to code diagnoses correctly and create targeted treatments that help patients with predominantly inattentive ADHD.
Essential Components of F90.0 Documentation
Medical professionals need precision and a full picture to document F90.0 accurately. This ensures diagnostic accuracy, effective treatment, and insurance reimbursement. Documentation must capture several critical components beyond just noting the code.
Symptom presentation documentation
Clinical notes must clearly identify at least six inattentive symptoms (five for adults) [8] at the time of documenting inattentive ADHD (F90.0). These symptoms include:
Careless mistakes/poor attention to details
Difficulty sustaining attention in tasks or play
Seeming not to listen when directly addressed
Failure to follow through on instructions or finish tasks
Difficulty organizing tasks and activities
Avoidance of tasks requiring sustained mental effort
Losing necessary items for tasks/activities
Easy distraction by extraneous stimuli
Forgetfulness in daily activities [9]
Your clinical notes should include specific behavioral examples rather than just listing symptoms. To name just one example, instead of writing "patient has difficulty focusing," document observable behaviors like "patient requires frequent redirection during 15-minute reading tasks, looking away from material approximately every 2-3 minutes."
Functional impairment assessment
Documentation for F90.0 must show "clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning" [10]. This requirement sets clinically significant inattention apart from occasional focus problems.
These standardized assessment tools help document functional impairment effectively:
Vanderbilt Assessment Scales: Include specific items (questions 48-55 on parent scale, 36-43 on teacher scale) that assess functional impairment [11]
Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P): Covers wide functional domains and measures changes over time with a minimal important difference (MID) of 0.25 points [12]
Impairment Rating Scale: Provides another standardized option for assessment [11]
Your notes should clearly link symptoms to functional difficulties in areas like academic performance, social relationships, or daily responsibilities.
Duration and setting requirements
Patients must show symptoms for at least six months [9] [8] to receive an F90.0 diagnosis. This duration requirement helps distinguish persistent attention deficits from temporary challenges.
Symptoms must also appear across multiple settings (minimum two) such as home, school, work, or social environments [10]. This cross-setting verification prevents misdiagnosis of situation-specific attention problems as ADHD.
You can document multi-setting evidence through:
Detailed interviews with parents, teachers, and other caregivers
Rating scales completed by observers in different contexts
Direct behavioral observations across settings when possible
Ruling out alternative explanations
A valid F90.0 diagnosis requires elimination of other conditions that might better explain inattentive symptoms. The ICD-10 specifically excludes several conditions:
Anxiety disorders (F40.-, F41.-)
Mood/affective disorders (F30-F39)
Pervasive developmental disorders (F84.-)
Schizophrenia (F20.-) [13]
Your documentation should also address common ADHD comorbidities:
Learning disabilities
Language disorders
Disruptive behavior disorders
Sleep disorders
Tic disorders [14]
Identifying comorbidities might change the ADHD treatment approach in some cases [14]. A comprehensive differential diagnosis documentation strengthens both clinical decision-making and reimbursement justification.
Note that ICD-10 outpatient coding guidelines state that terms like "rule out," "working diagnosis," or similar phrases indicate uncertainty. In such cases, report symptom codes rather than diagnosis codes until confirmation [15].
Initial Assessment Documentation for ICD-10 F90.0
The original assessment phase builds the foundation to document F90.0 diagnoses accurately. A detailed evaluation needs multiple tools and sources to confirm both inattentive symptoms and their severity.
Structured interview documentation techniques
F90.0 assessment starts with properly documented structured interviews. The Diagnostic Interview for ADHD in Adults (DIVA) and Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) have showed high diagnostic reliability and validity [16]. The ADHD Child Evaluation (ACE) gives clinicians a systematic framework that guides them through diagnosing children aged 5-16 [2].
Your structured interview documentation should capture these vital elements:
Onset: Note symptom appearance (must be before age 12 for DSM-5 criteria) [2]
Duration: Document symptoms lasting at least six months [2]
Pervasiveness: Record symptoms showing up in multiple contexts [2]
Persistence: Note how often symptoms occur compared to developmental norms [2]
Impairment: Document how symptoms affect functioning [2]
Adolescent cases need information from at least two teachers plus other sources like coaches or school counselors [17]. Complex cases benefit from neuropsychological testing notes that help clarify the diagnosis [17].
Rating scale integration in notes
DSM-based rating scales are a vital part of F90.0 documentation. These tools help determine core ADHD symptoms as defined by DSM-5 criteria [18]. Assessment notes must include completed rating scales from at least two major settings [18].
Children and adolescents (6-18 years) need documented results from age-appropriate tools:
Vanderbilt Assessment Scales (both parent and teacher versions)
ADHD Rating Scale-5 (home and school versions)
Conners Rating Scales (Conners 3) [18]
Research shows the "average" algorithm works better than both the "or" algorithm (symptom present if either parent OR teacher endorses it) and the "and" algorithm (symptom present only if both agree) [19]. This averaging method shows 72% valid variance compared to just 30-41% with the "and" approach [19].
Documenting evidence from multiple settings
F90.0 documentation needs symptom verification in different environments. Your notes should think over other environmental or behavioral factors if symptoms appear in only one setting [17].
Your notes must include these elements to establish cross-setting evidence:
Teacher assessments using standardized tools [17]
Parent/caregiver reports covering home behaviors [17]
School reports or direct classroom observations [2]
Preschoolers and children under 5 typically show "some level of hyperactivity and impulsivity" but you should still document inattentive behaviors [1]. Rapid symptom onset isn't typical for ADHD and needs documentation as a potential sign of alternative diagnoses [1].
The original assessment documentation must establish that symptoms occur in "two or more settings (e.g., at home, school, or work)" and "clearly interfere with or reduce the quality of social, academic, or occupational functioning" to meet ICD-10 F90.0 diagnostic criteria.
Treatment Plan Documentation for Inattentive ADHD
Doctors need precise documentation to create treatment plans that work for patients with predominantly inattentive ADHD (F90.0). This documentation supports both clinical care and insurance requirements. A detailed treatment plan guides healthcare providers to address specific inattention symptoms and track patient's progress against set standards.
Setting measurable goals related to inattention symptoms
Your F90.0 treatment documentation should start by establishing 3-5 target outcomes that guide intervention strategies. These goals must follow the SMART framework—Specific, Measurable, Attainable, Realistic, and Timely [21]. The documentation for patients with inattentive ADHD should:
Track behaviors you can count or rate [22]
Target functional improvements at home, school, or work [22]
Record baseline measurements to track progress
Professional goals could target "completing a specific number of daily tasks" or "recalling assignment details with X number of reminders" [6]. Social goals might focus on "having conversations without interrupting others" or "remembering commitments to friends and family" [6].
Documenting selected interventions with rationale
Your plan must clearly show your chosen interventions and clinical reasoning. The standard care for inattentive ADHD (F90.0) typically has:
For children 6+ years: FDA-approved medications plus parent training in behavior management and/or behavioral classroom interventions [23]. You should document your reasoning for each part of this multi-faceted approach.
Research shows that combining medication with behavioral therapy usually gives better results [23]. Your notes should specify behavioral strategies like organizational skills training, reward systems, or changes to the environment [24].
Medication monitoring documentation (when applicable)
A treatment plan with medication needs detailed documentation that has:
Original medication choice with clinical reasoning [25]
Baseline symptom measurements before starting medication [26]
Regular check-ups (every 2-4 weeks at first, then every 12-24 weeks) [1]
Regular tracking of main symptoms (inattention, hyperactivity, impulsivity) [26]
Side effects tracking using standard scales [26]
Your notes should show medication adjustments made to "achieve maximum benefit with tolerable side effects" [3]. This ongoing monitoring helps prove that you're "titrating doses of medication to achieve maximum benefit" as clinical guidelines suggest [14].
Progress Note Best Practices for F90.0 Diagnosis Code
Doctors need to pay close attention to detail and follow standard formats when they document predominantly inattentive ADHD cases. Good progress notes help track how well treatments work. They also support ongoing care and help with insurance claims for the F90.0 diagnosis code.
SOAP note structure for inattentive ADHD sessions
The SOAP framework helps doctors document F90.0 treatment sessions effectively. Each part looks at different aspects of inattentive ADHD care:
Subjective: Write down what patients say about their attention difficulties. Direct quotes capture the patient's viewpoint accurately [5]. Note how often symptoms occur, how intense they are, and how they affect daily life at home, school, or work.
Objective: Watch and record behaviors during the session like fidgeting, poor eye contact, or restlessness [27]. Add results from ADHD rating scales done since the last visit [5]. These measurements back up what you observed.
Assessment: Combine subjective and objective information to review treatment progress. Note any changes in how severe symptoms are and how well the patient functions [28]. With F90.0, focus your review on inattention rather than hyperactivity or impulsivity.
Plan: Map out the next steps in treatment. This might mean adjusting medication, changing behavioral therapy, or making referrals [28]. Write clear follow-up instructions with specific timelines [5].
Tracking symptom changes over time
Good F90.0 management needs careful monitoring of how symptoms change. We don't have as many standard tools to track ADHD treatment as we do for anxiety or depression. Still, several methods work well:
Use the same rating scales regularly to measure symptom changes [7]
Write down specific improvements in attention span, task completion, and organization [7]
Keep track of how patients do in school, work, and social situations [5]
Add specific measurements that matter to each patient, like how often they finish homework or how productive they are at work.
Documenting treatment adherence and barriers
F90.0 patients often struggle with following treatment plans because they tend to forget things and have trouble staying organized [4]. Your notes should:
Show the difference between patients who choose not to follow recommendations and those who want to but can't [4]
Write down specific problems with following treatment (missed medications, lost prescriptions, skipped appointments) [4]
Record what patients think about medication benefits and side effects [29]
Note any concerns about identity ("medication changes who I am") that might affect treatment [4]
List support strategies you've put in place (daily routines, parent oversight, memory aids) [29]
Regular checks of vital signs (blood pressure, weight, height) help patients stick to treatment by catching side effects early [29].
Conclusion
Proper F90.0 documentation plays a vital role in ADHD treatment and insurance claims. Documenting inattentive ADHD can be tricky. A well-laid-out approach will give a solid clinical record that helps patient care and meets administrative needs.
SOAP notes should track changes in symptoms, how well patients stick to treatment, and improvements in their daily life. Your notes need specific examples of behaviors instead of general comments. Use standard assessment tools and rating scales to back up your observations.
The core elements of good F90.0 documentation are simple. Monitor symptoms consistently. Explain treatment decisions clearly. Check progress regularly. These steps will help you create therapy notes that guide treatment and satisfy both clinical and insurance needs.
FAQs
What does the F90.0 diagnosis code represent in the ICD-10 framework?
F90.0 is the code for Attention-deficit hyperactivity disorder, predominantly inattentive type. It falls under the category of mental, behavioral, and neurodevelopmental disorders in the ICD-10-CM classification system and specifically identifies patients who display primarily inattentive symptoms without significant hyperactivity or impulsivity.
How many symptoms are required for an F90.0 diagnosis?
For an F90.0 diagnosis, patients must display at least six of the nine inattention symptoms for children up to age 16, or five symptoms for individuals 17 and older. These symptoms must persist for at least six months, appear in multiple settings, and significantly interfere with the patient's functioning.
What are the essential components of F90.0 documentation?
Essential components of F90.0 documentation include detailed symptom presentation, functional impairment assessment, duration and setting requirements, and ruling out alternative explanations. Clinicians should use specific behavioral examples, standardized assessment tools, and evidence from multiple settings to support the diagnosis.
How should treatment plans for inattentive ADHD be documented?
Treatment plans for inattentive ADHD should include measurable goals related to inattention symptoms, clearly documented interventions with clinical rationale, and, when applicable, comprehensive medication monitoring. Goals should follow the SMART framework and address functional impairments in various settings.
What is the recommended structure for progress notes in F90.0 cases?
The SOAP (Subjective, Objective, Assessment, Plan) framework is recommended for structuring progress notes in F90.0 cases. Notes should track symptom changes over time, document treatment adherence and barriers, and include specific behavioral improvements in attention span, task completion, and organization.
References
[1] - https://mn.gov/dhs/assets/Hyperactivity Disorder Assessment %26 Treatment_tcm1053-572140.pdf
[2] - https://advancedassessments.co.uk/resources/ADHD-Screening-Test-Child.pdf
[3] - https://publications.aap.org/pediatrics/article/144/4/e20192528/81590/Clinical-Practice-Guideline-for-the-Diagnosis
[4] - https://www.ncbi.nlm.nih.gov/books/NBK578100/
[5] - https://neurolaunch.com/adhd-soap-note/
[6] - https://medvidi.com/blog/treatment-goals-for-adhd-how-to-set-them-right
[7] - https://www.psychologytoday.com/us/blog/1-2-3-adhd/202306/tracking-symptom-severity-in-adhd
[8] - https://www.osmind.org/knowledge-article/adhd-icd-10-code-guide
[9] - https://www.mdclarity.com/icd-codes/f90-0
[10] - https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/
[11] - https://www.childrensmercy.org/health-care-providers/evidence-based-practice/cpgs-cpms-and-eras-pathways/attention-deficit-hyperactivity-disorder-care-process-model/adhd-assessment-options-for-assessing-functional-impairment/
[12] - https://www.mbhregistry.com/mips_quality_measure/2021-mbhr-measure-outcome-monitoring-of-adhd-functional-impairment-in-children-and-youth/
[13] - https://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F90-/F90.0
[14] - https://pmc.ncbi.nlm.nih.gov/articles/PMC7067282/
[15] - https://www.outsourcestrategies.com/blog/documenting-coding-attention-deficit-hyperactivity-disorder-adhd/
[16] - https://pmc.ncbi.nlm.nih.gov/articles/PMC7735513/
[17] - https://www.choc.org/files/mental_health_toolkit/provider/adhd/ADHD_Toolkit_COMPLETE_Provider_English.pdf
[18] - https://eqipp.aap.org/courses/adhd/mn/clinical-guide/popups/dsm-based-adhd-rating-scales
[19] - https://pmc.ncbi.nlm.nih.gov/articles/PMC4549180/
[21] - https://www.addrc.org/setting-target-goals-for-adhd/
[22] - https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Treatment-of-ADHD-and-Related-Disorders.aspx
[23] - https://www.cdc.gov/adhd/hcp/treatment-recommendations/index.html
[24] - https://www.healthline.com/health/adhd/inattentive-type
[25] - https://www.ncbi.nlm.nih.gov/books/NBK441838/
[26] - https://www.aacap.org/App_Themes/AACAP/docs/member_resources/toolbox_for_clinical_practice_and_outcomes/monitoring/stimulant_monitoring_form_for_children_and_adolescents.pdf
[27] - https://onlinenursingpapers.com/adhd-soap-note-example/
[28] - https://nursemygrade.com/adhd-soap-note-template-example
[29] - https://www.consultant360.com/articles/adhd-treatment-strategies-optimizing-adherence
