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v1.0.0
ICD-10 Guide
ICD-10 CodesQ74.0

Q74.0

Billable

Other congenital malformations of upper limb(s), including shoulder girdle

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

Code Description

ICD-10 Q74.0 is a billable code used to indicate a diagnosis of other congenital malformations of upper limb(s), including shoulder girdle.

Key Diagnostic Point:

Congenital malformations of the upper limbs, including the shoulder girdle, encompass a variety of structural abnormalities that can affect the bones, muscles, and soft tissues. These malformations may arise from genetic factors, environmental influences, or a combination of both. Common conditions include limb reduction defects, where one or more limbs are underdeveloped or absent, and deformities such as clubfoot or congenital hip dysplasia, which can affect limb function and mobility. Scoliosis, while primarily a spinal condition, can also be associated with upper limb malformations due to compensatory mechanisms. Accurate diagnosis often involves imaging studies and genetic testing to determine the underlying cause and to guide treatment options. Early intervention is crucial for optimizing functional outcomes and may include physical therapy, orthopedic interventions, or surgical correction. The complexity of these conditions necessitates a multidisciplinary approach, involving pediatricians, orthopedic surgeons, and geneticists to provide comprehensive care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of malformations
  • Need for detailed documentation of associated conditions
  • Potential for multiple congenital anomalies requiring coding
  • Differentiation from acquired conditions

Audit Risk Factors

  • Inadequate documentation of the specific malformation
  • Failure to capture associated congenital anomalies
  • Misclassification of congenital versus acquired conditions
  • Lack of genetic testing documentation when applicable

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes describing the malformation, functional impact, and any associated conditions.

Common Clinical Scenarios

Assessment of a newborn with limb reduction defects or a child with clubfoot.

Billing Considerations

Consideration of developmental milestones and functional assessments in pediatric patients.

Genetics

Documentation Requirements

Genetic testing results, family history, and any syndromic associations.

Common Clinical Scenarios

Genetic counseling for families with a history of congenital limb malformations.

Billing Considerations

Understanding the genetic basis of malformations to guide treatment and family planning.

Coding Guidelines

Inclusion Criteria

Use Q74.0 When
  • Follow the official ICD
  • CM coding guidelines for congenital conditions, ensuring accurate documentation of the malformation type, associated conditions, and any relevant family history

Exclusion Criteria

Do NOT use Q74.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used in conjunction with treatment for congenital malformations affecting joint function.

Documentation Requirements

Document the indication for the procedure and any associated conditions.

Specialty Considerations

Orthopedic specialists may require additional imaging documentation.

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 data accuracy and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving data accuracy and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving data accuracy and facilitating better patient 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 documentation is required for coding Q74.0?

Documentation must include a detailed description of the malformation, any associated conditions, and the impact on function. Genetic testing results should also be included when applicable.