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ICD-10 Guide
ICD-10 CodesQ21.2

Q21.2

Billable

Atrioventricular septal defect

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

Code Description

ICD-10 Q21.2 is a billable code used to indicate a diagnosis of atrioventricular septal defect.

Key Diagnostic Point:

Atrioventricular septal defect (AVSD) is a congenital heart defect characterized by a combination of atrial septal defect (ASD) and ventricular septal defect (VSD), along with a single common atrioventricular valve instead of separate mitral and tricuspid valves. This condition results in abnormal blood flow between the heart chambers, leading to increased pulmonary blood flow and potential heart failure if left untreated. AVSD can occur as an isolated defect or as part of a genetic syndrome, such as Down syndrome. Symptoms may include difficulty breathing, poor feeding, and failure to thrive in infants. Diagnosis is typically made through echocardiography, which reveals the structural abnormalities. Surgical intervention is often required to repair the defect and improve cardiac function, usually performed in early childhood. Long-term follow-up is essential to monitor for potential complications, including arrhythmias and valve dysfunction.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of the defect
  • Potential association with genetic syndromes
  • Need for detailed documentation of surgical interventions
  • Complexity in distinguishing from other congenital heart defects

Audit Risk Factors

  • Inadequate documentation of associated conditions or syndromes
  • Failure to capture all surgical interventions performed
  • Misclassification of the defect type
  • Inconsistent coding of follow-up care

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes on symptoms, diagnostic imaging results, and treatment plans are essential. Documentation should include growth parameters and developmental milestones.

Common Clinical Scenarios

Infants presenting with respiratory distress, failure to thrive, or heart murmurs during routine examinations.

Billing Considerations

Consideration of the patient's age and weight is crucial for determining the timing of surgical intervention.

Genetics

Documentation Requirements

Genetic testing results, family history of congenital defects, and any syndromic associations should be documented.

Common Clinical Scenarios

Patients with AVSD being evaluated for genetic syndromes, such as Down syndrome, or those with a family history of congenital heart disease.

Billing Considerations

Understanding the genetic implications and counseling families about recurrence risks is vital.

Coding Guidelines

Inclusion Criteria

Use Q21.2 When
  • Follow the official ICD
  • CM coding guidelines for congenital malformations, ensuring accurate documentation of the defect type, associated conditions, and any surgical interventions performed

Exclusion Criteria

Do NOT use Q21.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

33533CPT Code

Repair of atrioventricular septal defect

Clinical Scenario

Used during surgical intervention for AVSD repair.

Documentation Requirements

Operative report detailing the procedure performed and any complications.

Specialty Considerations

Pediatric cardiology and cardiothoracic surgery documentation must align.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital heart defects, improving the accuracy of data collection and reimbursement for complex cases like AVSD.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital heart defects, improving the accuracy of data collection and reimbursement for complex cases like AVSD.

Reimbursement & Billing Impact

reimbursement for complex cases like AVSD.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Congenital Heart Disease

Coding & Billing References

  • •
    American Academy of Pediatrics - Congenital Heart Disease

Frequently Asked Questions

What is the significance of coding AVSD accurately?

Accurate coding of AVSD is crucial for appropriate reimbursement, tracking of congenital heart defects, and ensuring that patients receive the necessary follow-up care and interventions.