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ICD-10 Guide
ICD-10 CodesQ22.9

Q22.9

Billable

Congenital malformation of tricuspid valve, unspecified

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

Code Description

ICD-10 Q22.9 is a billable code used to indicate a diagnosis of congenital malformation of tricuspid valve, unspecified.

Key Diagnostic Point:

Congenital malformations of the tricuspid valve can lead to significant hemodynamic alterations and clinical manifestations in affected individuals. The tricuspid valve, located between the right atrium and right ventricle, plays a crucial role in maintaining proper blood flow through the heart. Malformations may include structural abnormalities such as tricuspid atresia, which is characterized by the absence of the valve, or dysplastic changes that affect its function. These conditions can result in right heart failure, cyanosis, and other complications. Diagnosis typically involves echocardiography, which can visualize the valve's structure and function. Management may require surgical intervention, particularly in severe cases, to correct the malformation and improve cardiac output. The complexity of these conditions often necessitates a multidisciplinary approach, including pediatric cardiology, surgery, and genetic counseling, especially when associated with syndromic presentations or chromosomal abnormalities.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of tricuspid valve malformations.
  • Need for detailed echocardiographic findings for accurate coding.
  • Potential association with other congenital heart defects.
  • Documentation of clinical symptoms and interventions required.

Audit Risk Factors

  • Inadequate documentation of the specific type of tricuspid valve malformation.
  • Failure to document associated congenital heart defects.
  • Lack of clarity in the clinical significance of the malformation.
  • Inconsistent coding practices across different healthcare providers.

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical history, physical examination findings, and results from echocardiography are essential for accurate coding.

Common Clinical Scenarios

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

Billing Considerations

Consideration of the patient's age and developmental milestones is crucial in pediatric coding.

Genetics

Documentation Requirements

Genetic testing results, family history of congenital conditions, and syndromic associations must be documented.

Common Clinical Scenarios

Patients with congenital heart defects may undergo genetic counseling to assess for chromosomal abnormalities or syndromes.

Billing Considerations

Understanding the genetic implications of congenital heart defects is vital for accurate coding and patient management.

Coding Guidelines

Inclusion Criteria

Use Q22.9 When
  • Follow the ICD
  • CM Official Guidelines for Coding and Reporting, which emphasize the importance of specificity in coding congenital conditions
  • Ensure that all relevant clinical information is documented to support the diagnosis

Exclusion Criteria

Do NOT use Q22.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

93306CPT Code

Echocardiography, transthoracic, real-time with interpretation and report

Clinical Scenario

Used to evaluate congenital heart defects, including tricuspid valve malformations.

Documentation Requirements

Echocardiographic findings must be documented in the medical record.

Specialty Considerations

Pediatric cardiologists often perform these evaluations.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Academy of Pediatrics Coding Resources

Coding & Billing References

  • •
    American Academy of Pediatrics Coding Resources

Frequently Asked Questions

What is the significance of coding Q22.9?

Coding Q22.9 indicates an unspecified congenital malformation of the tricuspid valve, which is important for tracking congenital heart defects and ensuring appropriate management and follow-up for affected patients.