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ICD-10 Guide
ICD-10 CodesQ14.1

Q14.1

Billable

Congenital malformation of retina

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

Code Description

ICD-10 Q14.1 is a billable code used to indicate a diagnosis of congenital malformation of retina.

Key Diagnostic Point:

Congenital malformation of the retina refers to a range of developmental anomalies affecting the retina, which can lead to visual impairment or blindness. These malformations may include conditions such as retinal dysplasia, coloboma, and retinopathy of prematurity. The retina is crucial for vision as it converts light into neural signals. Malformations can arise from genetic factors, environmental influences, or a combination of both during fetal development. Clinical manifestations vary widely, from mild visual disturbances to severe vision loss. Diagnosis typically involves a comprehensive eye examination, including fundus photography and optical coherence tomography (OCT). Early detection and intervention are essential for managing these conditions, particularly in pediatric patients, to optimize visual outcomes and support developmental milestones.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of retinal malformations.
  • Need for detailed documentation of visual function and associated symptoms.
  • Potential overlap with other congenital eye conditions requiring careful differentiation.
  • Involvement of multiple specialties (pediatrics, ophthalmology, genetics) in management.

Audit Risk Factors

  • Inadequate documentation of visual impairment severity.
  • Failure to specify associated congenital anomalies.
  • Misclassification of retinal malformations with other eye conditions.
  • Lack of genetic testing documentation when applicable.

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include detailed visual assessments, family history of congenital conditions, and developmental milestones.

Common Clinical Scenarios

Common scenarios include routine screenings for premature infants, evaluations for strabismus, and assessments for developmental delays.

Billing Considerations

Considerations include the impact of visual impairment on overall development and the need for multidisciplinary care.

Genetics

Documentation Requirements

Genetic documentation should include family history, results of genetic testing, and any syndromic associations.

Common Clinical Scenarios

Scenarios include genetic counseling for families with a history of retinal malformations and evaluations for syndromic conditions like CHARGE syndrome.

Billing Considerations

Considerations include the need for genetic testing to identify underlying chromosomal abnormalities that may be associated with retinal malformations.

Coding Guidelines

Inclusion Criteria

Use Q14.1 When
  • Follow official ICD
  • CM guidelines for coding congenital conditions, ensuring accurate documentation of the specific type of malformation and any associated conditions

Exclusion Criteria

Do NOT use Q14.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination

Clinical Scenario

Used for comprehensive eye exams in patients with congenital retinal malformations.

Documentation Requirements

Document visual acuity, fundoscopic findings, and any interventions.

Specialty Considerations

Ophthalmologists should ensure thorough documentation of findings and treatment 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.

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.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Academy of Pediatrics

Coding & Billing References

  • •
    American Academy of Pediatrics

Frequently Asked Questions

What documentation is required for coding Q14.1?

Documentation should include a detailed clinical assessment of the retinal condition, visual function tests, and any relevant imaging studies. Additionally, any associated congenital anomalies should be documented to support the diagnosis.