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ICD-10 Guide
ICD-10 CodesQ13.89

Q13.89

Billable

Other congenital malformations of anterior segment of eye

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

Code Description

ICD-10 Q13.89 is a billable code used to indicate a diagnosis of other congenital malformations of anterior segment of eye.

Key Diagnostic Point:

Congenital malformations of the anterior segment of the eye encompass a variety of structural abnormalities that can affect vision and ocular health. These malformations may include conditions such as anophthalmia (absence of one or both eyes), microphthalmia (abnormally small eyes), and other anomalies affecting the cornea, iris, and lens. These conditions can arise from genetic factors, environmental influences, or a combination of both during fetal development. Anophthalmia and microphthalmia are often associated with chromosomal abnormalities, such as trisomy 13 or 18, and may present alongside other congenital anomalies, including cleft lip and palate or branchial cysts. Early diagnosis and intervention are crucial for managing these conditions, as they can significantly impact a child's visual development and overall quality of life. Treatment options may include surgical interventions, prosthetic eyes, and supportive therapies to enhance visual function and psychosocial adaptation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of congenital eye malformations
  • Need for precise documentation of associated conditions
  • Potential overlap with other congenital codes
  • Requirement for genetic testing results in some cases

Audit Risk Factors

  • Inadequate documentation of associated congenital conditions
  • Failure to specify laterality (e.g., unilateral vs. bilateral)
  • Misclassification of congenital malformations as acquired conditions
  • Lack of genetic testing documentation when applicable

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed pediatric history, including prenatal and family history, and developmental milestones.

Common Clinical Scenarios

Diagnosis of congenital eye malformations during routine pediatric examinations, referrals for visual impairment assessments.

Billing Considerations

Consideration of developmental delays and the need for multidisciplinary care involving ophthalmology, genetics, and rehabilitation services.

Genetics

Documentation Requirements

Genetic testing results, family history of congenital anomalies, and any syndromic associations.

Common Clinical Scenarios

Genetic counseling for families with a history of congenital eye malformations, evaluation for syndromic conditions.

Billing Considerations

Understanding the implications of chromosomal abnormalities and the need for comprehensive genetic evaluations.

Coding Guidelines

Inclusion Criteria

Use Q13.89 When
  • Follow official ICD
  • CM guidelines for coding congenital conditions, ensuring accurate documentation of the condition's nature, associated anomalies, and any relevant genetic information

Exclusion Criteria

Do NOT use Q13.89 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

66984CPT Code

Surgical repair of congenital cataract

Clinical Scenario

Used in cases where congenital cataract is present alongside other anterior segment anomalies.

Documentation Requirements

Document the specific type of congenital cataract and any associated conditions.

Specialty Considerations

Ophthalmology should provide detailed operative notes and follow-up care plans.

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 accuracy of data collection and reimbursement processes for these complex conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the accuracy of data collection and reimbursement processes for these complex conditions.

Reimbursement & Billing Impact

reimbursement processes for these complex conditions.

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 documentation is required for coding Q13.89?

Documentation must include a detailed clinical description of the congenital malformation, any associated conditions, and results from genetic testing if applicable. Ensure that the laterality of the condition is clearly stated.