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ICD-10 Guide
ICD-10 CodesQ10.6

Q10.6

Billable

Other congenital malformations of lacrimal apparatus

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

Code Description

ICD-10 Q10.6 is a billable code used to indicate a diagnosis of other congenital malformations of lacrimal apparatus.

Key Diagnostic Point:

Congenital malformations of the lacrimal apparatus can manifest as various structural anomalies affecting tear production and drainage. These malformations may include conditions such as congenital nasolacrimal duct obstruction, which can lead to excessive tearing (epiphora) and recurrent eye infections. Other potential anomalies may involve the lacrimal glands or ducts, resulting in impaired tear film stability and ocular surface health. In pediatric patients, these conditions often present early in life, necessitating careful evaluation and management to prevent complications such as corneal damage or chronic conjunctivitis. The diagnosis typically involves a thorough clinical examination, including observation of tear production and drainage, and may require imaging studies to assess the anatomy of the lacrimal system. Treatment options vary based on the severity of the malformation and may include surgical intervention to restore normal function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of malformations
  • Need for detailed anatomical understanding for accurate coding
  • Potential overlap with other congenital conditions affecting the eye
  • Documentation requirements for surgical interventions

Audit Risk Factors

  • Inadequate documentation of the specific malformation
  • Failure to link the diagnosis with appropriate treatment
  • Misclassification of the condition due to overlapping symptoms
  • Lack of clarity in the clinical notes regarding the severity of the malformation

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include detailed descriptions of symptoms, onset, and any associated conditions. Growth and development assessments are also crucial.

Common Clinical Scenarios

Common scenarios include infants presenting with excessive tearing or recurrent conjunctivitis, requiring evaluation for nasolacrimal duct obstruction.

Billing Considerations

Consideration must be given to the age of the patient and the potential for spontaneous resolution of certain conditions.

Genetics

Documentation Requirements

Genetic documentation should include family history, any known syndromic associations, and results from genetic testing if applicable.

Common Clinical Scenarios

Scenarios may involve genetic counseling for families with a history of congenital eye anomalies or syndromes associated with lacrimal apparatus malformations.

Billing Considerations

Genetic syndromes may present with multiple congenital anomalies, necessitating a comprehensive approach to coding.

Coding Guidelines

Inclusion Criteria

Use Q10.6 When
  • Official coding guidelines for congenital conditions emphasize the importance of specificity in documentation, including the exact nature of the malformation and any associated conditions
  • Coders should ensure that the diagnosis is supported by clinical findings and that any surgical interventions are appropriately linked to the diagnosis

Exclusion Criteria

Do NOT use Q10.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

68801CPT Code

Dilation of nasolacrimal duct

Clinical Scenario

Used in cases of congenital nasolacrimal duct obstruction.

Documentation Requirements

Documentation must include indications for the procedure and any pre-operative assessments.

Specialty Considerations

Pediatric specialists should ensure that the procedure is justified based on clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the accuracy of data collection and reimbursement processes. This specificity aids in better understanding the prevalence and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the accuracy of data collection and reimbursement processes. This specificity aids in better understanding the prevalence and management of these conditions.

Reimbursement & Billing Impact

reimbursement processes. This specificity aids in better understanding the prevalence and management of these conditions.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common congenital malformations of the lacrimal apparatus?

Common congenital malformations include congenital nasolacrimal duct obstruction, which can lead to excessive tearing and recurrent infections, and structural anomalies affecting the lacrimal glands. Accurate coding requires detailed documentation of the specific malformation and its clinical implications.