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v1.0.0
ICD-10 Guide
ICD-10 CodesQ25.4

Q25.4

Billable

Other congenital malformations of aorta

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

Code Description

ICD-10 Q25.4 is a billable code used to indicate a diagnosis of other congenital malformations of aorta.

Key Diagnostic Point:

Congenital malformations of the aorta encompass a variety of structural abnormalities that can significantly impact cardiovascular function. These malformations may include conditions such as aortic arch anomalies, interrupted aortic arch, and other less common variations that do not fall under more specific categories. The aorta, being the main artery that carries oxygenated blood from the heart to the rest of the body, is crucial for maintaining systemic circulation. Congenital defects can lead to serious complications, including heart failure, hypertension, and increased risk of stroke. Diagnosis often involves imaging studies such as echocardiography, MRI, or CT scans, which help visualize the aorta's structure and blood flow. Treatment may require surgical intervention, particularly in cases of significant obstruction or malformation, to restore normal blood flow and prevent further complications. Early detection and management are essential for improving outcomes in affected individuals, particularly in pediatric populations where these conditions are often diagnosed at birth or during early childhood.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of specific aortic malformations that may not be well-defined
  • Need for precise documentation of the type and severity of the malformation
  • Potential for coexisting congenital heart defects that complicate coding
  • Variability in clinical presentation and management approaches

Audit Risk Factors

  • Inadequate documentation of the specific type of aortic malformation
  • Failure to capture associated congenital heart defects
  • Misinterpretation of imaging results leading to incorrect coding
  • Lack of clarity in the clinical narrative regarding the severity of the condition

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include detailed descriptions of the malformation, associated symptoms, and any interventions performed. Growth and developmental assessments may also be relevant.

Common Clinical Scenarios

Common scenarios include newborns diagnosed with aortic coarctation during routine examinations or children presenting with heart murmurs requiring further evaluation.

Billing Considerations

Consideration must be given to the age of the patient and the potential for growth-related changes in the aorta.

Genetics

Documentation Requirements

Genetic documentation should include family history, genetic testing results, and any syndromic associations with congenital heart defects.

Common Clinical Scenarios

Scenarios may involve genetic counseling for families with a history of congenital heart defects or syndromes associated with aortic malformations.

Billing Considerations

Coders should be aware of the genetic syndromes that may predispose individuals to aortic malformations, such as Turner syndrome or Marfan syndrome.

Coding Guidelines

Inclusion Criteria

Use Q25.4 When
  • According to ICD
  • CM guidelines, congenital malformations should be coded based on the specific anatomical and physiological characteristics
  • Coders must ensure that the documentation supports the diagnosis and reflects the complexity of the condition

Exclusion Criteria

Do NOT use Q25.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

33405CPT Code

Repair of coarctation of aorta

Clinical Scenario

Used in cases where surgical intervention is required for aortic malformations.

Documentation Requirements

Operative reports detailing the procedure and indications for surgery.

Specialty Considerations

Pediatric cardiology may require additional documentation regarding the patient's growth and development.

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 ability to capture the complexity of these conditions and their management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the ability to capture the complexity of these conditions and their management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the ability to capture the complexity of these conditions and their management.

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 types of conditions are included under Q25.4?

Q25.4 includes various congenital malformations of the aorta that do not fall under more specific categories, such as interrupted aortic arch or other structural anomalies. Coders should refer to clinical documentation to determine the exact nature of the malformation.