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ICD-10 Guide
ICD-10 CodesQ14.9

Q14.9

Billable

Congenital malformation of posterior segment of eye, unspecified

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

Code Description

ICD-10 Q14.9 is a billable code used to indicate a diagnosis of congenital malformation of posterior segment of eye, unspecified.

Key Diagnostic Point:

Congenital malformations of the posterior segment of the eye encompass a range of structural anomalies that can affect vision and ocular health. These malformations may include conditions such as coloboma, which is a defect in the eye structure, and retinal dysplasia, where the retina does not develop properly. The posterior segment includes the retina, choroid, and vitreous body, and abnormalities in these areas can lead to significant visual impairment or blindness. The etiology of these malformations can be multifactorial, including genetic predispositions, environmental factors, and teratogenic influences during pregnancy. Diagnosis typically involves comprehensive ophthalmic examinations, imaging studies, and genetic testing when indicated. Management strategies may vary from observation to surgical interventions, depending on the severity and impact on vision. Early detection and intervention are crucial for optimizing visual outcomes in affected children.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of malformations
  • Need for detailed ophthalmic examination and imaging
  • Potential overlap with other congenital eye conditions
  • Documentation of associated systemic anomalies

Audit Risk Factors

  • Inadequate documentation of the specific malformation
  • Failure to document associated conditions or syndromes
  • Misuse of unspecified codes leading to potential denials
  • Lack of genetic testing results when relevant

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include detailed developmental history, family history of congenital conditions, and results from pediatric ophthalmologic assessments.

Common Clinical Scenarios

Common scenarios include referrals for strabismus, amblyopia, or unexplained visual impairment in infants and children.

Billing Considerations

Consideration must be given to the age of the child and the potential for developmental delays associated with visual impairments.

Genetics

Documentation Requirements

Genetic documentation should include family pedigree, results of chromosomal analysis, and any syndromic associations with congenital eye malformations.

Common Clinical Scenarios

Genetic counseling for families with a history of congenital eye malformations or syndromes that include ocular anomalies.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use Q14.9 When
  • Follow official ICD
  • CM coding guidelines for congenital conditions, ensuring specificity and accuracy in documentation
  • Use additional codes to capture associated conditions or syndromes when applicable

Exclusion Criteria

Do NOT use Q14.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination, comprehensive, established patient

Clinical Scenario

Used for routine follow-up of patients with congenital eye malformations.

Documentation Requirements

Document visual acuity, ocular health, and any interventions performed.

Specialty Considerations

Pediatric ophthalmologists may require additional details on developmental milestones.

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, enabling better tracking of these conditions and their management. However, it has also increased the complexity of coding due to the need for detailed documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, enabling better tracking of these conditions and their management. However, it has also increased the complexity of coding due to the need for detailed documentation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, enabling better tracking of these conditions and their management. However, it has also increased the complexity of coding due to the need for detailed documentation.

Resources

Clinical References

  • •
    American Academy of Pediatrics
  • •
    American Academy of Ophthalmology
  • •
    Genetics Home Reference

Coding & Billing References

  • •
    American Academy of Pediatrics
  • •
    American Academy of Ophthalmology
  • •
    Genetics Home Reference

Frequently Asked Questions

What is the significance of coding congenital malformations accurately?

Accurate coding of congenital malformations is crucial for appropriate patient management, resource allocation, and research. It ensures that patients receive the necessary interventions and follow-up care, and it helps in understanding the epidemiology of these conditions.