Congenital dislocation of hip, unspecified
ICD-10 Q65.2 is a billable code used to indicate a diagnosis of congenital dislocation of hip, unspecified.
Congenital dislocation of the hip (CDH) is a condition where the femoral head is not properly seated in the acetabulum of the pelvis. This malformation can occur due to a variety of factors, including genetic predisposition, mechanical factors during pregnancy, and environmental influences. The condition is often diagnosed in infancy through physical examination and imaging studies. Symptoms may include limited range of motion, asymmetry in leg length, and a characteristic 'click' or 'clunk' during hip movement. Early diagnosis and intervention are crucial to prevent long-term complications such as osteoarthritis and functional impairment. Treatment typically involves bracing, physical therapy, or surgical intervention depending on the severity of the dislocation. In the context of congenital malformations, it is essential to consider associated conditions such as renal agenesis, polycystic kidney disease, bladder exstrophy, and posterior urethral valves, which may co-occur and complicate the clinical picture.
Detailed pediatric history, physical examination findings, and treatment plans must be documented. Growth and developmental milestones should also be noted.
Common scenarios include newborn screening for hip dysplasia, follow-up visits for bracing, and surgical interventions for severe cases.
Consideration of family history of congenital conditions and the need for multidisciplinary care involving orthopedics and physical therapy.
Genetic counseling notes, family pedigree charts, and results from genetic testing should be included in the documentation.
Scenarios may involve assessing the risk of recurrence in future pregnancies and evaluating for syndromic associations with congenital dislocation.
Genetic factors contributing to congenital dislocation should be explored, including chromosomal abnormalities that may predispose to musculoskeletal malformations.
Used in cases where non-surgical management fails and surgical intervention is necessary.
Operative reports detailing the procedure, indications, and post-operative care.
Orthopedic specialists should provide detailed documentation of the surgical approach and any complications.
Documentation should include a detailed clinical history, physical examination findings, imaging results, treatment plans, and any associated congenital anomalies. It is essential to specify laterality and severity to ensure accurate coding.
