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v1.0.0
ICD-10 Guide
ICD-10 CodesQ85.81

Q85.81

Billable

PTEN hamartoma tumor syndrome

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

Code Description

ICD-10 Q85.81 is a billable code used to indicate a diagnosis of pten hamartoma tumor syndrome.

Key Diagnostic Point:

PTEN hamartoma tumor syndrome (PHTS) is a genetic disorder characterized by the presence of multiple hamartomas, which are benign tumors that can occur in various tissues, including the skin, breast, and gastrointestinal tract. This syndrome is associated with mutations in the PTEN gene, which plays a crucial role in regulating cell growth and division. Patients with PHTS may present with skin lesions such as trichilemmomas, acral keratoses, and lipomas, as well as an increased risk for certain cancers, particularly breast and thyroid cancers. Other congenital malformations may include developmental delays and neurodevelopmental disorders. The diagnosis is often made through clinical evaluation and genetic testing to identify PTEN mutations. Management typically involves regular surveillance for malignancies and symptomatic treatment of hamartomas. Given the complexity of the syndrome and its manifestations, accurate coding is essential for appropriate patient management and resource allocation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation among patients
  • Need for genetic testing documentation
  • Potential overlap with other syndromes
  • Requirement for multidisciplinary care coordination

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to capture all associated congenital malformations
  • Misclassification of benign tumors as malignant
  • Lack of comprehensive patient history

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed family history, growth and development assessments, and documentation of any congenital anomalies.

Common Clinical Scenarios

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

Billing Considerations

Ensure thorough documentation of all congenital anomalies and their management to support coding.

Genetics

Documentation Requirements

Genetic testing results, family pedigree, and detailed clinical findings related to PHTS.

Common Clinical Scenarios

Genetic counseling sessions for families with a history of PTEN mutations or related syndromes.

Billing Considerations

Accurate coding requires clear documentation of genetic findings and their implications for patient management.

Coding Guidelines

Inclusion Criteria

Use Q85.81 When
  • Follow official ICD
  • CM guidelines for coding congenital conditions, ensuring that all manifestations and associated conditions are documented and coded appropriately

Exclusion Criteria

Do NOT use Q85.81 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81214CPT Code

PTEN gene analysis

Clinical Scenario

Used for confirming diagnosis in patients suspected of having PHTS.

Documentation Requirements

Genetic testing results and clinical findings must be documented.

Specialty Considerations

Genetic specialists should ensure comprehensive documentation to support the necessity of testing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of genetic conditions like PHTS, improving the accuracy of patient records and facilitating better management strategies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of genetic conditions like PHTS, improving the accuracy of patient records and facilitating better management strategies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of genetic conditions like PHTS, improving the accuracy of patient records and facilitating better management strategies.

Resources

Clinical References

  • •
    National Organization for Rare Disorders (NORD)

Coding & Billing References

  • •
    National Organization for Rare Disorders (NORD)

Frequently Asked Questions

What is the significance of coding PTEN hamartoma tumor syndrome accurately?

Accurate coding of PTEN hamartoma tumor syndrome is crucial for ensuring appropriate patient management, facilitating access to necessary screenings, and supporting research into the condition. It also helps in tracking the prevalence and outcomes of this genetic disorder.