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v1.0.0
ICD-10 Guide
ICD-10 CodesQ85.09

Q85.09

Billable

Other neurofibromatosis

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

Code Description

ICD-10 Q85.09 is a billable code used to indicate a diagnosis of other neurofibromatosis.

Key Diagnostic Point:

Other neurofibromatosis encompasses a range of congenital conditions characterized by the presence of neurofibromas, which are benign tumors arising from nerve tissue. These tumors can occur in various locations throughout the body and may be associated with other congenital malformations, such as skin lesions, breast tissue abnormalities, and anomalies of the spleen and adrenal glands. Neurofibromatosis type 1 (NF1) is the most common form, often presenting with café-au-lait spots, freckling, and Lisch nodules. However, other forms of neurofibromatosis, such as neurofibromatosis type 2 (NF2) and schwannomatosis, may present differently and require careful differentiation. The clinical management of these conditions often involves a multidisciplinary approach, including dermatology, genetics, and oncology, particularly when there is a risk of malignant transformation. Accurate coding is essential for proper treatment planning and insurance reimbursement, as these conditions can have significant implications for the patient's health and quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of presentations and associated congenital conditions
  • Need for detailed clinical documentation to support diagnosis
  • Differentiation from other neurocutaneous syndromes
  • Potential for overlapping symptoms with other congenital malformations

Audit Risk Factors

  • Inadequate documentation of associated congenital conditions
  • Misclassification of neurofibromatosis types
  • Failure to document the extent of neurofibromas
  • Inconsistent coding of related skin lesions

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include growth patterns, developmental milestones, and any associated congenital anomalies.

Common Clinical Scenarios

Pediatric patients presenting with skin lesions, developmental delays, or family history of neurofibromatosis.

Billing Considerations

Consideration of age-related manifestations and the impact of congenital conditions on growth and development.

Genetics

Documentation Requirements

Genetic documentation must include family history, genetic testing results, and counseling notes.

Common Clinical Scenarios

Patients undergoing genetic counseling for familial neurofibromatosis or presenting with multiple congenital anomalies.

Billing Considerations

Understanding the genetic basis of neurofibromatosis and its inheritance patterns is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use Q85.09 When
  • Follow the official ICD
  • CM coding guidelines for congenital conditions, ensuring that all relevant clinical information is documented to support the diagnosis
  • Coders should be familiar with the guidelines for coding congenital malformations and the importance of specificity

Exclusion Criteria

Do NOT use Q85.09 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit

Clinical Scenario

Used for follow-up visits in patients with neurofibromatosis.

Documentation Requirements

Document history, examination findings, and management plan.

Specialty Considerations

Pediatricians should focus on growth and developmental assessments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding neurofibromatosis, enabling better tracking of the condition and its associated congenital anomalies. This specificity aids in research and improves patient care by ensuring appropriate treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding neurofibromatosis, enabling better tracking of the condition and its associated congenital anomalies. This specificity aids in research and improves patient care by ensuring appropriate treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding neurofibromatosis, enabling better tracking of the condition and its associated congenital anomalies. This specificity aids in research and improves patient care by ensuring appropriate treatment plans.

Resources

Clinical References

  • •
    Neurofibromatosis Network

Coding & Billing References

  • •
    Neurofibromatosis Network

Frequently Asked Questions

What is the difference between neurofibromatosis type 1 and type 2?

Neurofibromatosis type 1 is characterized by café-au-lait spots and neurofibromas, while type 2 is primarily associated with bilateral vestibular schwannomas and hearing loss. Accurate coding requires understanding these differences.