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ICD-10 Guide
ICD-10 CodesQ22.4

Q22.4

Billable

Congenital tricuspid stenosis

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

Code Description

ICD-10 Q22.4 is a billable code used to indicate a diagnosis of congenital tricuspid stenosis.

Key Diagnostic Point:

Congenital tricuspid stenosis is a rare heart defect characterized by the narrowing of the tricuspid valve, which impedes blood flow from the right atrium to the right ventricle. This condition can lead to increased pressure in the right atrium and may result in right heart failure if not addressed. Patients may present with symptoms such as cyanosis, fatigue, and signs of heart failure. The stenosis can be isolated or associated with other congenital heart defects, such as atrial septal defects or ventricular septal defects. Diagnosis is typically made through echocardiography, which can visualize the structure and function of the heart valves. Treatment often involves surgical intervention to repair or replace the tricuspid valve, especially in symptomatic patients. Early detection and management are crucial to improving outcomes and preventing complications associated with this congenital malformation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of symptoms
  • Potential association with other congenital heart defects
  • Need for detailed echocardiographic findings for accurate coding
  • Variations in surgical interventions and follow-up care

Audit Risk Factors

  • Inadequate documentation of the severity of stenosis
  • Failure to document associated congenital anomalies
  • Misclassification of the condition as acquired rather than congenital
  • Inconsistent use of diagnostic imaging results

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Documentation should include detailed clinical findings, echocardiographic results, and any surgical interventions performed.

Common Clinical Scenarios

Pediatric patients presenting with heart murmurs, failure to thrive, or cyanosis may require evaluation for congenital tricuspid stenosis.

Billing Considerations

Consideration of growth and development impacts on management and follow-up care is essential.

Genetics

Documentation Requirements

Genetic counseling documentation should include family history, potential syndromic associations, and genetic testing results if applicable.

Common Clinical Scenarios

Patients with congenital tricuspid stenosis may be evaluated for genetic syndromes, especially if associated with other anomalies.

Billing Considerations

Awareness of chromosomal abnormalities that may co-occur with congenital heart defects is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use Q22.4 When
  • Follow the official ICD
  • CM coding guidelines for congenital conditions, ensuring accurate documentation of the congenital nature of the defect and any associated conditions

Exclusion Criteria

Do NOT use Q22.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

33405CPT Code

Repair of tricuspid valve

Clinical Scenario

Used during surgical intervention for congenital tricuspid stenosis.

Documentation Requirements

Document the indication for surgery, findings during the procedure, and post-operative care.

Specialty Considerations

Pediatric cardiology may require additional documentation regarding the patient's growth and development post-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 heart defects, improving the accuracy of data collection and reimbursement processes for congenital tricuspid stenosis.

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 processes for congenital tricuspid stenosis.

Reimbursement & Billing Impact

reimbursement processes for congenital tricuspid stenosis.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Congenital Heart Disease

Coding & Billing References

  • •
    American Academy of Pediatrics - Congenital Heart Disease

Frequently Asked Questions

What are the common associated conditions with congenital tricuspid stenosis?

Common associated conditions include atrial septal defects, ventricular septal defects, and other congenital heart defects. Genetic syndromes may also be present, necessitating thorough evaluation.