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ICD-10 Guide
ICD-10 CodesChapter 17: Congenital malformations and chromosomal abnormalitiesQ11

Q11

Non-billable

Anophthalmos, microphthalmos and macrophthalmos

Chapter 17:Congenital malformations and chromosomal abnormalities

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 Q11 is a used to indicate a diagnosis of anophthalmos, microphthalmos and macrophthalmos.

Key Diagnostic Point:

The ICD-10 Level 1 Category code Q11 encompasses conditions related to anophthalmos, microphthalmos, and macrophthalmos. Anophthalmos refers to the congenital absence of one or both eyes, while microphthalmos denotes abnormally small eyes that may lead to visual impairment. Macrophthalmos, on the other hand, is characterized by abnormally large eyes, which can also be associated with various ocular and systemic conditions. These congenital anomalies can significantly impact an individual's quality of life, necessitating early diagnosis and intervention to manage associated complications and to provide appropriate visual rehabilitation when possible.

  • Clinically, these conditions can be linked to genetic syndromes or environmental factors during pregnancy, making them critical for early screening and genetic counseling. The usage of Q11 codes is essential for accurate medical record-keeping, facilitating research and epidemiological studies, and ensuring appropriate reimbursement for the care provided. Proper coding helps in tracking the prevalence of these conditions and understanding their implications in broader public health contexts.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation
  • Need for multidisciplinary management
  • Potential for associated syndromes

Audit Risk Factors

  • Inadequate documentation of associated conditions
  • Misclassification of severity
  • Failure to capture all affected anatomical sites

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Genetics

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of the Q11 code category is significant, as it relates to congenital conditions that can affect a patient's visual development and overall quality of life. Early identification and intervention can lead to better outcomes, including improved visual function and psychosocial adjustment. Furthermore, tracking these conditions through accurate coding can inform public health initiatives aimed at understanding the prevalence and etiology of congenital eye anomalies.
Administratively, the accurate use of Q11 codes can enhance data collection for research and quality improvement initiatives. It can also influence healthcare trends by highlighting the need for specialized services and resources for affected populations. As awareness of these conditions grows, healthcare providers can better advocate for necessary support and funding for research and treatment options.

ICD-9 vs ICD-10

The clinical impact of the Q11 code category is significant, as it relates to congenital conditions that can affect a patient's visual development and overall quality of life. Early identification and intervention can lead to better outcomes, including improved visual function and psychosocial adjustment. Furthermore, tracking these conditions through accurate coding can inform public health initiatives aimed at understanding the prevalence and etiology of congenital eye anomalies. Administratively, the accurate use of Q11 codes can enhance data collection for research and quality improvement initiatives. It can also influence healthcare trends by highlighting the need for specialized services and resources for affected populations. As awareness of these conditions grows, healthcare providers can better advocate for necessary support and funding for research and treatment options.

Reimbursement & Billing Impact

reimbursement rates may vary based on the complexity of the case and the services provided.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for Q11

Coding & Billing References

  • •
    Official ICD-10 Guidelines for Q11

Frequently Asked Questions

What conditions are included in Q11?

Q11 includes anophthalmos, microphthalmos, and macrophthalmos, which are congenital eye anomalies affecting eye size and presence.

When should I use Q11 codes?

Use Q11 codes when documenting cases of congenital absence or abnormal size of the eyes, particularly in newborns and children.

What documentation is required for Q11?

Documentation should include clinical findings, diagnostic imaging results, and any associated syndromic conditions to support the diagnosis.