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ICD-10 Guide
ICD-10 CodesQ83.9

Q83.9

Billable

Congenital malformation of breast, unspecified

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

Code Description

ICD-10 Q83.9 is a billable code used to indicate a diagnosis of congenital malformation of breast, unspecified.

Key Diagnostic Point:

Congenital malformations of the breast can encompass a variety of conditions that affect breast development and morphology. These malformations may include hypoplasia (underdevelopment), aplasia (absence of breast tissue), or other structural anomalies. The breast tissue may be affected by genetic syndromes or environmental factors during fetal development. In pediatric patients, these conditions can lead to psychosocial issues as the child matures, particularly during puberty when breast development is expected. Diagnosis typically involves clinical examination and may be supplemented by imaging studies. The management of congenital breast malformations often requires a multidisciplinary approach, including pediatricians, surgeons, and, in some cases, geneticists, especially if associated with syndromic features. The unspecified nature of this code indicates that the specific type of malformation is not documented, which can complicate treatment planning and genetic counseling.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of breast malformations
  • Need for detailed clinical documentation to specify type of malformation
  • Potential association with genetic syndromes requiring additional coding
  • Differentiation from acquired breast conditions

Audit Risk Factors

  • Inadequate documentation of the specific type of malformation
  • Failure to link the malformation to associated syndromes
  • Misuse of unspecified codes leading to potential denials
  • Lack of follow-up documentation on management and outcomes

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed growth and development assessments, family history, and psychosocial evaluations.

Common Clinical Scenarios

Evaluation of breast development in a prepubescent child, referral for surgical intervention, or genetic counseling for syndromic cases.

Billing Considerations

Consideration of the psychosocial impact on the child and family, and the need for a supportive care plan.

Genetics

Documentation Requirements

Genetic testing results, family pedigree, and documentation of any syndromic associations.

Common Clinical Scenarios

Assessment of congenital breast malformations in the context of genetic syndromes like Turner syndrome or Poland syndrome.

Billing Considerations

Understanding the genetic basis of malformations and the implications for family members.

Coding Guidelines

Inclusion Criteria

Use Q83.9 When
  • Follow ICD
  • CM guidelines for coding congenital conditions, ensuring specificity when possible
  • Document the clinical findings thoroughly and consider the implications of associated syndromes

Exclusion Criteria

Do NOT use Q83.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19316CPT Code

Breast reconstruction

Clinical Scenario

Used in cases of significant breast malformation requiring surgical intervention.

Documentation Requirements

Preoperative assessment, surgical notes, and postoperative follow-up.

Specialty Considerations

Pediatric surgical considerations for growth and development.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for greater specificity in coding congenital malformations, which can improve patient care and resource allocation. However, the unspecified nature of Q83.9 may lead to challenges in accurately capturing the complexity of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 allows for greater specificity in coding congenital malformations, which can improve patient care and resource allocation. However, the unspecified nature of Q83.9 may lead to challenges in accurately capturing the complexity of these conditions.

Reimbursement & Billing Impact

The transition to ICD-10 allows for greater specificity in coding congenital malformations, which can improve patient care and resource allocation. However, the unspecified nature of Q83.9 may lead to challenges in accurately capturing the complexity of these conditions.

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 should I document for congenital breast malformations?

Document the clinical findings, any associated syndromes, family history, and psychosocial impact. Include imaging results and any referrals for surgical or genetic evaluation.