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v1.0.0
ICD-10 Guide
ICD-10 CodesD81.4

D81.4

Billable

Nezelof's syndrome

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D81.4 is a billable code used to indicate a diagnosis of nezelof's syndrome.

Key Diagnostic Point:

Nezelof's syndrome is a rare immunodeficiency disorder characterized by a specific defect in T-cell development, leading to a lack of T-lymphocytes and associated immunological dysfunction. This condition is classified under the group of severe combined immunodeficiencies (SCID) and is often associated with other hematological abnormalities, including hypogammaglobulinemia. Patients with Nezelof's syndrome typically present with recurrent infections, particularly viral and fungal infections, due to their compromised immune system. The syndrome is also associated with various hematological manifestations, such as anemia and thrombocytopenia, which can complicate the clinical picture. Diagnosis is often made through a combination of clinical evaluation, immunological testing, and genetic studies to identify the underlying defect in T-cell maturation. Management of Nezelof's syndrome may involve immunoglobulin replacement therapy, prophylactic antibiotics, and in some cases, hematopoietic stem cell transplantation to restore immune function. Due to its rarity and complexity, accurate coding and documentation are crucial for appropriate patient management and reimbursement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition leading to limited familiarity among coders.
  • Need for precise documentation of immunological testing results.
  • Potential for overlapping symptoms with other immunodeficiencies.
  • Complexity in distinguishing between primary and secondary immunodeficiencies.

Audit Risk Factors

  • Inadequate documentation of immunological assessments.
  • Misclassification of the syndrome as a more common immunodeficiency.
  • Failure to document associated hematological conditions.
  • Lack of clarity in the clinical narrative regarding the patient's history.

Specialty Focus

Medical Specialties

Immunology

Documentation Requirements

Detailed immunological test results, patient history of infections, and treatment plans.

Common Clinical Scenarios

Patients presenting with recurrent infections, failure to thrive, or unusual infections.

Billing Considerations

Ensure all immunological evaluations are documented to support the diagnosis.

Hematology

Documentation Requirements

Complete blood counts, bone marrow biopsy results, and any hematological abnormalities.

Common Clinical Scenarios

Patients with anemia or thrombocytopenia in the context of immunodeficiency.

Billing Considerations

Document any co-existing hematological conditions that may influence treatment.

Coding Guidelines

Inclusion Criteria

Use D81.4 When
  • Follow the official ICD
  • CM coding guidelines for immunodeficiencies, ensuring accurate documentation of the patient's clinical presentation and laboratory findings
  • Include any relevant co
  • morbid conditions that may affect treatment and management

Exclusion Criteria

Do NOT use D81.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

86317CPT Code

Immunologic testing for T-cell function

Clinical Scenario

Used when evaluating a patient suspected of having Nezelof's syndrome.

Documentation Requirements

Document the rationale for testing and results.

Specialty Considerations

Immunologists should ensure comprehensive documentation of all test results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of rare conditions like Nezelof's syndrome, improving the accuracy of patient records and facilitating better management of these complex cases.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like Nezelof's syndrome, improving the accuracy of patient records and facilitating better management of these complex cases.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of rare conditions like Nezelof's syndrome, improving the accuracy of patient records and facilitating better management of these complex cases.

Resources

Clinical References

  • •
    National Organization for Rare Disorders (NORD)

Coding & Billing References

  • •
    National Organization for Rare Disorders (NORD)

Frequently Asked Questions

What is Nezelof's syndrome?

Nezelof's syndrome is a rare immunodeficiency disorder characterized by a defect in T-cell development, leading to severe immune dysfunction and increased susceptibility to infections.