Congenital malformations of eye, ear, face and neck

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 Q20-Q28 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 to identify any associated conditions.
• •If a patient has multiple congenital malformations, each should be coded separately.
• •For newborns, also use a code from Z38, Liveborn infants, to identify birth status.
• •Remember to code also any associated syndromes.

When to Use:

• ✓When a patient presents with a congenital malformation of the eye, ear, face, or neck.
• ✓When a patient has a history of a congenital malformation that impacts their current health status.
• ✓When a patient's congenital malformation is being surgically corrected.
• ✓When a patient's congenital malformation is causing other health complications.

When NOT to Use:

• ✗When a patient's condition is acquired, not congenital.
• ✗When a patient's condition is not related to the eye, ear, face, or neck.
• ✗When a patient's condition is not a malformation, but a different type of disorder.
• ✗When the condition is not present, but there is a family history of it.

Common Documentation Errors:

• ⚠Not specifying the exact type of malformation
• ⚠Not indicating the location of the malformation
• ⚠Not documenting related conditions or complications
• ⚠Not documenting surgical procedures