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v1.0.0
ICD-10 Guide
ICD-10 CodesQ85.0

Q85.0

Billable

Neurofibromatosis (nonmalignant)

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

Code Description

ICD-10 Q85.0 is a billable code used to indicate a diagnosis of neurofibromatosis (nonmalignant).

Key Diagnostic Point:

Neurofibromatosis (NF) is a genetic disorder characterized by the development of multiple benign tumors called neurofibromas, which arise from the peripheral nervous system. It is classified into two main types: NF1 and NF2, with NF1 being the most common. NF1 is associated with café-au-lait spots, freckling in the axillary or groin regions, and Lisch nodules (iris hamartomas). Patients may also experience learning disabilities and other neurological complications. The condition is caused by mutations in the NF1 gene located on chromosome 17. Neurofibromatosis is considered a congenital malformation due to its genetic basis and early onset, often presenting in childhood. While the tumors are nonmalignant, they can lead to significant morbidity due to their location and size. Management typically involves regular monitoring and surgical intervention when necessary. Accurate coding of neurofibromatosis requires careful documentation of the clinical features and any associated complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity among patients.
  • Need for detailed documentation of associated symptoms and complications.
  • Differentiation between NF1 and NF2 for accurate coding.
  • Potential for co-occurring congenital conditions that may complicate coding.

Audit Risk Factors

  • Inadequate documentation of the specific type of neurofibromatosis.
  • Failure to document associated conditions or complications.
  • Misclassification of neurofibromatosis as a malignant condition.
  • Inconsistent coding practices across different healthcare settings.

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include growth and developmental assessments, family history, and any neurological evaluations.

Common Clinical Scenarios

Common scenarios include routine monitoring of neurofibromas, management of learning disabilities, and referrals for surgical evaluation.

Billing Considerations

Considerations include the age of onset, family history of neurofibromatosis, and the presence of other congenital anomalies.

Genetics

Documentation Requirements

Genetic documentation should include results of genetic testing, family pedigree, and counseling notes regarding inheritance patterns.

Common Clinical Scenarios

Genetic counseling for families with a history of neurofibromatosis and discussions about the implications of genetic testing.

Billing Considerations

Considerations include the need for genetic testing to confirm diagnosis and assess risk for family members.

Coding Guidelines

Inclusion Criteria

Use Q85.0 When
  • Follow the official ICD
  • CM guidelines for coding congenital conditions, ensuring accurate documentation of the type of neurofibromatosis and any associated conditions
  • Use additional codes as necessary to capture complications

Exclusion Criteria

Do NOT use Q85.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for routine follow-up visits for patients with neurofibromatosis.

Documentation Requirements

Document history, examination findings, and any management plans.

Specialty Considerations

Pediatricians should focus on developmental assessments during visits.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of neurofibromatosis, enabling better tracking of the condition and its complications. This specificity aids in research and improves patient care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neurofibromatosis, enabling better tracking of the condition and its complications. This specificity aids in research and improves patient care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neurofibromatosis, enabling better tracking of the condition and its complications. This specificity aids in research and improves patient care.

Resources

Clinical References

  • •
    Neurofibromatosis Network

Coding & Billing References

  • •
    Neurofibromatosis Network

Frequently Asked Questions

What is the difference between NF1 and NF2?

NF1 is characterized by skin lesions and neurological complications, while NF2 primarily involves tumors affecting hearing. Accurate coding requires distinguishing between the two types based on clinical findings.