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v1.0.0
ICD-10 Guide
ICD-10 CodesQ11.1

Q11.1

Billable

Other anophthalmos

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

Code Description

ICD-10 Q11.1 is a billable code used to indicate a diagnosis of other anophthalmos.

Key Diagnostic Point:

Other anophthalmos refers to a congenital condition characterized by the absence of one or both eyes, which is not classified as complete anophthalmia. This condition can arise from various genetic and environmental factors during fetal development. Anophthalmos may be associated with other congenital malformations, particularly those affecting the face and neck, such as cleft lip and palate, and branchial cysts. The absence of the eye can lead to significant visual impairment and may require multidisciplinary management, including surgical interventions, prosthetic fitting, and psychological support. The condition can also be linked to chromosomal abnormalities, such as trisomy 13 or 18, necessitating thorough genetic evaluation and counseling for affected families. Accurate coding of anophthalmos is crucial for appropriate treatment planning and resource allocation in pediatric care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between complete and partial anophthalmos.
  • Association with other congenital anomalies.
  • Need for genetic testing and counseling documentation.
  • Variability in clinical presentation and severity.

Audit Risk Factors

  • Inadequate documentation of associated congenital anomalies.
  • Failure to document genetic counseling or testing.
  • Misclassification of anophthalmos severity.
  • Inconsistent coding of related procedures.

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes on the child's developmental history, associated anomalies, and treatment plans.

Common Clinical Scenarios

Management of anophthalmos in infants, including prosthetic eye fitting and surgical interventions.

Billing Considerations

Consideration of psychosocial impacts on the child and family, as well as the need for ongoing developmental assessments.

Genetics

Documentation Requirements

Genetic testing results, family history, and counseling notes regarding the risk of recurrence.

Common Clinical Scenarios

Evaluation of anophthalmos in the context of syndromic presentations and chromosomal abnormalities.

Billing Considerations

Importance of genetic counseling for families, including implications for future pregnancies.

Coding Guidelines

Inclusion Criteria

Use Q11.1 When
  • Coders should adhere to official ICD
  • 10 guidelines, ensuring accurate documentation of the condition's severity, associated anomalies, and any genetic testing performed
  • It is essential to capture the full clinical picture to support the diagnosis and treatment plan

Exclusion Criteria

Do NOT use Q11.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67901CPT Code

Repair of anophthalmos

Clinical Scenario

Used when surgical intervention is performed for anophthalmos.

Documentation Requirements

Surgical notes detailing the procedure and any associated findings.

Specialty Considerations

Ophthalmology-specific documentation may be required.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital conditions like anophthalmos, improving the accuracy of data collection and resource allocation for affected patients.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital conditions like anophthalmos, improving the accuracy of data collection and resource allocation for affected patients.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital conditions like anophthalmos, improving the accuracy of data collection and resource allocation for affected patients.

Resources

Clinical References

  • •
    Congenital Anomalies: A Guide for Clinicians

Coding & Billing References

  • •
    Congenital Anomalies: A Guide for Clinicians

Frequently Asked Questions

What is the difference between anophthalmos and microphthalmia?

Anophthalmos refers to the complete absence of one or both eyes, while microphthalmia is characterized by abnormally small eyes that may still have some visual function. Accurate coding requires distinguishing between these two conditions based on clinical findings.