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v1.0.0
ICD-10 Guide
ICD-10 CodesQ87.5

Q87.5

Billable

Other congenital malformation syndromes with other skeletal changes

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

Code Description

ICD-10 Q87.5 is a billable code used to indicate a diagnosis of other congenital malformation syndromes with other skeletal changes.

Key Diagnostic Point:

Q87.5 encompasses a variety of congenital malformation syndromes that present with skeletal changes not classified under more specific codes. These syndromes may include a range of anomalies affecting the skin, breast, spleen, adrenal glands, and other rare malformations. Conditions such as ectodermal dysplasia, which can lead to skin and hair abnormalities, or congenital adrenal hyperplasia, which may affect adrenal gland function and lead to skeletal changes, fall under this category. The skeletal changes can manifest as limb deformities, spinal anomalies, or other structural abnormalities that may not fit neatly into other classifications. Accurate coding requires a thorough understanding of the patient's clinical presentation and the specific syndromes involved, as these can significantly impact treatment and management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of syndromes included under this code
  • Overlap with other congenital malformations
  • Need for detailed clinical documentation
  • Potential for multiple co-existing conditions

Audit Risk Factors

  • Inadequate documentation of specific syndromes
  • Misclassification of syndromes leading to incorrect coding
  • Failure to capture co-existing conditions
  • Lack of clarity in clinical notes regarding skeletal changes

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Documentation must include detailed descriptions of the child's growth and development, specific skeletal anomalies, and any associated congenital conditions.

Common Clinical Scenarios

Common scenarios include evaluations for limb deformities, assessments for syndromic presentations, and follow-up visits for management of congenital conditions.

Billing Considerations

Pediatric coders should be aware of the developmental implications of congenital malformations and ensure that all relevant information is captured in the medical record.

Genetics

Documentation Requirements

Genetic testing results, family history, and detailed descriptions of the genetic syndromes must be documented to support the diagnosis.

Common Clinical Scenarios

Scenarios may include genetic counseling sessions, diagnostic evaluations for suspected syndromes, and management plans for genetic conditions.

Billing Considerations

Genetic coders should focus on the implications of chromosomal abnormalities and ensure that all genetic testing and counseling services are accurately coded.

Coding Guidelines

Inclusion Criteria

Use Q87.5 When
  • Coders should adhere to the official ICD
  • CM coding guidelines, ensuring that all congenital conditions are documented with specificity
  • It is crucial to capture the full clinical picture, including any associated anomalies or syndromes

Exclusion Criteria

Do NOT use Q87.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81200CPT Code

Genetic testing for congenital malformations

Clinical Scenario

Used in conjunction with Q87.5 for genetic evaluation of syndromic conditions.

Documentation Requirements

Documentation of clinical indications for testing and results.

Specialty Considerations

Genetic specialists should ensure that all relevant syndromic features are documented.

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 the ability to capture the complexity of these conditions. Q87.5 provides a broader category for syndromes that may not fit neatly into other classifications, enhancing the accuracy of coding.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the ability to capture the complexity of these conditions. Q87.5 provides a broader category for syndromes that may not fit neatly into other classifications, enhancing the accuracy of coding.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the ability to capture the complexity of these conditions. Q87.5 provides a broader category for syndromes that may not fit neatly into other classifications, enhancing the accuracy of coding.

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 types of conditions are included under Q87.5?

Q87.5 includes a variety of congenital malformation syndromes that present with skeletal changes, such as ectodermal dysplasia and congenital adrenal hyperplasia, along with other rare malformations affecting skin, breast, spleen, and adrenal glands.