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v1.0.0
ICD-10 Guide
ICD-10 CodesQ25.1

Q25.1

Billable

Coarctation of aorta

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

Code Description

ICD-10 Q25.1 is a billable code used to indicate a diagnosis of coarctation of aorta.

Key Diagnostic Point:

Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aorta, typically occurring just distal to the left subclavian artery. This condition can lead to significant complications due to the increased workload on the left ventricle and reduced blood flow to the lower body. Symptoms may vary based on the severity of the coarctation and the age of the patient, with neonates often presenting with heart failure, poor feeding, and failure to thrive. In older children, symptoms may include hypertension in the upper body, diminished pulses in the lower extremities, and exercise intolerance. Diagnosis is typically made through echocardiography, chest X-ray, or MRI, which can reveal the characteristic narrowing and collateral circulation. Treatment often involves surgical intervention or balloon angioplasty to relieve the obstruction and restore normal blood flow. Long-term follow-up is essential to monitor for potential complications, including hypertension and re-coarctation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of the condition
  • Need for detailed documentation of symptoms and interventions
  • Potential for associated congenital heart defects
  • Variations in treatment approaches and follow-up care

Audit Risk Factors

  • Inconsistent documentation of symptoms and severity
  • Failure to capture associated congenital anomalies
  • Inaccurate coding of surgical interventions
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Documentation should include detailed clinical findings, imaging results, and treatment plans. Growth and developmental assessments are also crucial.

Common Clinical Scenarios

Common scenarios include newborns presenting with heart failure symptoms, older children with hypertension, and routine follow-ups post-surgery.

Billing Considerations

Coders should be aware of the age-specific manifestations and the potential for associated congenital heart defects.

Genetics

Documentation Requirements

Genetic counseling notes and family history should be documented, especially if there is a suspicion of syndromic associations.

Common Clinical Scenarios

Scenarios may include genetic testing for syndromes associated with congenital heart defects, such as Turner syndrome.

Billing Considerations

Consideration of chromosomal abnormalities that may co-occur with coarctation of the aorta is essential for accurate coding.

Coding Guidelines

Inclusion Criteria

Use Q25.1 When
  • Follow the official ICD
  • CM coding guidelines for congenital malformations, ensuring accurate documentation of the condition's severity, associated anomalies, and any surgical interventions

Exclusion Criteria

Do NOT use Q25.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

33405CPT Code

Repair of coarctation of aorta

Clinical Scenario

Used during surgical intervention for coarctation.

Documentation Requirements

Operative report detailing the procedure and any complications.

Specialty Considerations

Pediatric cardiology may have specific documentation needs.

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.

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.

Reimbursement & Billing Impact

reimbursement processes.

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 symptoms of coarctation of the aorta?

Common symptoms include difficulty breathing, poor feeding in infants, and high blood pressure in older children. Some may also experience diminished pulses in the lower extremities.