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ICD-10 Guide
ICD-10 CodesQ04.8

Q04.8

Billable

Other specified congenital malformations of brain

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 Q04.8 is a billable code used to indicate a diagnosis of other specified congenital malformations of brain.

Key Diagnostic Point:

Congenital malformations of the brain encompass a variety of structural abnormalities that occur during fetal development. These malformations can significantly impact neurological function and overall health. Conditions such as anencephaly, where a major portion of the brain and skull is absent, and spina bifida, characterized by the incomplete closure of the spinal column, are critical examples. Hydrocephalus, an accumulation of cerebrospinal fluid within the ventricles of the brain, can lead to increased intracranial pressure and requires careful management. Microcephaly, defined by an abnormally small head size, often correlates with developmental delays and cognitive impairments. Holoprosencephaly, a failure of the brain to properly divide into two hemispheres, can result in severe neurological deficits and facial deformities. Accurate coding of these conditions is essential for appropriate treatment planning and resource allocation in pediatric care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of conditions
  • Need for detailed documentation to support diagnosis
  • Differentiation between similar congenital malformations
  • Potential for co-occurring conditions requiring additional codes

Audit Risk Factors

  • Inadequate documentation of the specific malformation
  • Failure to capture co-existing conditions
  • Misclassification of the malformation type
  • Lack of clarity in the clinical narrative

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation must include detailed developmental assessments, imaging results, and treatment plans tailored to the child's specific malformation.

Common Clinical Scenarios

Common scenarios include newborns diagnosed with spina bifida requiring surgical intervention or infants with hydrocephalus needing shunt placement.

Billing Considerations

Consideration must be given to the age of the patient and the potential for growth and development, as well as the psychosocial impact on families.

Genetics

Documentation Requirements

Genetic documentation should include family history, genetic testing results, and any chromosomal abnormalities identified that may correlate with the congenital malformation.

Common Clinical Scenarios

Scenarios may involve genetic counseling for families with a history of congenital malformations or chromosomal abnormalities.

Billing Considerations

Genetic factors may play a significant role in the etiology of congenital malformations, necessitating thorough documentation of genetic assessments.

Coding Guidelines

Inclusion Criteria

Use Q04.8 When
  • Official coding guidelines for congenital and chromosomal conditions emphasize the importance of specificity and the need for comprehensive documentation to support the diagnosis
  • Coders should refer to the latest ICD
  • CM guidelines and updates from the American Academy of Pediatrics

Exclusion Criteria

Do NOT use Q04.8 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

74160CPT Code

Magnetic resonance imaging (MRI) of the brain

Clinical Scenario

Used for diagnosing congenital malformations in pediatric patients.

Documentation Requirements

MRI reports must include detailed findings and interpretations.

Specialty Considerations

Pediatric radiologists should be involved in interpreting imaging studies.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving data accuracy and enhancing the ability to track outcomes and resource utilization.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving data accuracy and enhancing the ability to track outcomes and resource utilization.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving data accuracy and enhancing the ability to track outcomes and resource utilization.

Resources

Clinical References

  • •
    American Academy of Pediatrics Coding Resources

Coding & Billing References

  • •
    American Academy of Pediatrics Coding Resources

Frequently Asked Questions

What documentation is required for coding Q04.8?

Documentation must include a clear diagnosis of the specific congenital malformation, imaging studies, treatment plans, and any relevant family history or genetic testing results.