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v1.0.0
ICD-10 Guide
ICD-10 CodesQ10.7

Q10.7

Billable

Congenital malformation of orbit

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

Code Description

ICD-10 Q10.7 is a billable code used to indicate a diagnosis of congenital malformation of orbit.

Key Diagnostic Point:

Congenital malformation of the orbit refers to a range of structural anomalies affecting the bony and soft tissue components surrounding the eye. These malformations can lead to significant visual impairment and may be associated with other congenital conditions. Common presentations include anophthalmia (absence of one or both eyes), microphthalmia (abnormally small eyes), and orbital deformities that can affect ocular alignment and function. These conditions often arise from genetic factors, teratogenic exposures, or disruptions during embryonic development. The orbit's malformation can also be linked to syndromic conditions, such as craniosynostosis syndromes or chromosomal abnormalities like trisomy 13 or 18. Accurate diagnosis typically involves a comprehensive clinical examination, imaging studies, and genetic testing when indicated. Management may require a multidisciplinary approach, including pediatric ophthalmology, genetics, and surgical intervention to address functional and aesthetic concerns.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of malformations
  • Need for comprehensive documentation of associated conditions
  • Potential for multiple congenital anomalies requiring coding
  • Differentiation between syndromic and isolated malformations

Audit Risk Factors

  • Inadequate documentation of associated congenital anomalies
  • Failure to specify laterality (unilateral vs. bilateral)
  • Misclassification of syndromic vs. non-syndromic conditions
  • Lack of genetic testing documentation when applicable

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes including family history, developmental milestones, and any associated anomalies.

Common Clinical Scenarios

Pediatric patients presenting with visual impairment, referral for genetic evaluation, or surgical intervention for orbital deformities.

Billing Considerations

Consideration of developmental delays and the need for multidisciplinary care in managing complex cases.

Genetics

Documentation Requirements

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

Common Clinical Scenarios

Patients with congenital malformations undergoing genetic counseling, evaluation for syndromic conditions, or prenatal diagnosis.

Billing Considerations

Understanding the implications of chromosomal abnormalities and their potential impact on management and prognosis.

Coding Guidelines

Inclusion Criteria

Use Q10.7 When
  • Follow the official ICD
  • CM coding guidelines for congenital conditions, ensuring accurate documentation of the malformation's nature, laterality, and any associated anomalies
  • Use additional codes as necessary to capture the full clinical picture

Exclusion Criteria

Do NOT use Q10.7 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67904CPT Code

Repair of congenital ptosis

Clinical Scenario

Used in cases where congenital malformations lead to ptosis requiring surgical intervention.

Documentation Requirements

Detailed operative notes and pre-operative assessments.

Specialty Considerations

Pediatric ophthalmology should document the rationale for surgery.

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 anomalies.

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 anomalies.

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 anomalies.

Resources

Clinical References

  • •
    CDC - Birth Defects
  • •
    American Academy of Pediatrics - Coding for Pediatric Care

Coding & Billing References

  • •
    CDC - Birth Defects
  • •
    American Academy of Pediatrics - Coding for Pediatric Care

Frequently Asked Questions

What documentation is required for coding Q10.7?

Documentation should include a detailed clinical assessment of the malformation, any associated congenital anomalies, genetic testing results if applicable, and a clear treatment plan. Ensure that laterality is specified when relevant.

How do I differentiate between congenital and acquired conditions?

Congenital conditions are present at birth and typically arise from genetic or environmental factors during pregnancy. Acquired conditions develop after birth due to injury or disease. Clear documentation of the patient's history and clinical findings is essential for accurate coding.