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ICD-10 Guide
ICD-10 CodesQ04.3

Q04.3

Billable

Other reduction deformities of brain

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

Code Description

ICD-10 Q04.3 is a billable code used to indicate a diagnosis of other reduction deformities of brain.

Key Diagnostic Point:

Q04.3 refers to congenital malformations characterized by a reduction in brain tissue, which can manifest in various forms such as microcephaly, holoprosencephaly, and other structural brain anomalies. These conditions often arise during early fetal development and can be associated with genetic syndromes or environmental factors. Anencephaly, a severe form of neural tube defect, results in the absence of a major portion of the brain, skull, and scalp. Spina bifida, while primarily a spinal defect, can also lead to associated brain malformations due to abnormal neural tube closure. Hydrocephalus, characterized by an accumulation of cerebrospinal fluid, can occur alongside these deformities, leading to increased intracranial pressure and further developmental challenges. Holoprosencephaly, where the brain fails to properly divide into two hemispheres, can result in facial deformities and cognitive impairments. Accurate coding of these conditions requires a thorough understanding of their clinical presentations and associated complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of associated congenital conditions
  • Need for precise documentation of clinical findings
  • Potential overlap with other congenital codes
  • Variability in presentation and severity of conditions

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to link diagnosis with appropriate procedures
  • Misclassification of severity or type of malformation
  • Lack of genetic testing documentation when applicable

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes including developmental assessments, imaging results, and family history.

Common Clinical Scenarios

Management of infants with microcephaly, follow-up care for children with spina bifida, and treatment plans for hydrocephalus.

Billing Considerations

Consideration of developmental milestones and potential interventions in coding.

Genetics

Documentation Requirements

Genetic testing results, family pedigree, and detailed descriptions of syndromic associations.

Common Clinical Scenarios

Counseling for families with a history of congenital malformations and interpretation of genetic tests.

Billing Considerations

Understanding of chromosomal abnormalities that may accompany brain malformations.

Coding Guidelines

Inclusion Criteria

Use Q04.3 When
  • Follow the official ICD
  • CM coding guidelines for congenital malformations, ensuring accurate linkage of diagnoses to clinical documentation and procedures performed

Exclusion Criteria

Do NOT use Q04.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit

Clinical Scenario

Used for follow-up visits in patients with congenital brain malformations.

Documentation Requirements

Document history, examination findings, and management plans.

Specialty Considerations

Pediatricians should focus on developmental assessments.

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 and their associated care needs.

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 and their associated care needs.

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 and their associated care needs.

Resources

Clinical References

  • •
    CDC - Birth Defects

Coding & Billing References

  • •
    CDC - Birth Defects

Frequently Asked Questions

What documentation is needed for coding Q04.3?

Documentation should include detailed clinical findings, imaging results, and any genetic testing that supports the diagnosis of reduction deformities of the brain.