Other congenital malformations

Historical Changes

• •FY 2025: Routine maintenance updates with minor terminology clarifications
• •FY 2024: Enhanced specificity requirements for certain code ranges
• •FY 2023: Updated documentation guidelines for improved clarity

Upcoming Changes

• •Proposed updates pending review by Coordination and Maintenance Committee
• •Under consideration: Enhanced digital health integration codes

Implementation Guidance

• •Review all FY 2026 updates for Q00-Q99 codes before implementation
• •Always verify the most current codes in the ICD-10-CM manual
• •Ensure clinical documentation supports the selected diagnosis codes
• +3 more guidance items...

Key Usage Points:

• •Always code to the highest level of specificity.
• •Use additional codes, if necessary, to identify any associated conditions.
• •Codes from this chapter are not for use on maternal records.
• •Use these codes only for congenital conditions, not for conditions that develop after birth.
• •In cases of laterality, if no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

When to Use:

• ✓When a baby is born with a physical abnormality, such as a cleft lip.
• ✓When a newborn has a congenital metabolic disorder, like phenylketonuria.
• ✓When a patient has a genetic syndrome present from birth, such as Down syndrome.
• ✓When a child has a congenital deformity, like clubfoot.
• ✓When a patient has a chromosomal abnormality, like Turner syndrome.

When NOT to Use:

• ✗When the condition developed after birth.
• ✗When the condition is not confirmed as congenital.
• ✗When the condition is an acquired deformity.
• ✗When the condition is a result of injury or trauma.
• ✗When the condition is a result of a disease process.

Common Documentation Errors:

• ⚠Not specifying the location of the malformation.
• ⚠Not confirming the condition as congenital.
• ⚠Not providing a detailed description of the malformation.
• ⚠Not documenting any associated conditions.