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ICD-10 Guide
ICD-10 CodesQ45.3

Q45.3

Billable

Other congenital malformations of pancreas and pancreatic duct

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

Code Description

ICD-10 Q45.3 is a billable code used to indicate a diagnosis of other congenital malformations of pancreas and pancreatic duct.

Key Diagnostic Point:

Congenital malformations of the pancreas and pancreatic duct can manifest in various forms, including agenesis, hypoplasia, or structural anomalies that can lead to significant digestive issues. These malformations may result in insufficient enzyme production, leading to malabsorption and nutritional deficiencies. In pediatric patients, these conditions often present with symptoms such as failure to thrive, abdominal pain, and recurrent pancreatitis. Diagnosis typically involves imaging studies such as ultrasound or MRI, alongside biochemical tests to assess pancreatic function. Management may require surgical intervention, nutritional support, and close monitoring of growth and development. Understanding the interplay between these malformations and other congenital digestive system anomalies, such as esophageal atresia or Hirschsprung disease, is crucial for comprehensive care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of pancreatic malformations
  • Need for detailed imaging and diagnostic criteria
  • Potential overlap with other congenital digestive disorders
  • Documentation of associated symptoms and complications

Audit Risk Factors

  • Inadequate documentation of the specific type of pancreatic malformation
  • Failure to document associated digestive symptoms
  • Misclassification of the condition due to overlapping symptoms with other congenital anomalies
  • Lack of clarity in the treatment plan and follow-up care

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include growth parameters, nutritional assessments, and developmental milestones.

Common Clinical Scenarios

Common scenarios include infants presenting with failure to thrive or recurrent abdominal pain due to pancreatic insufficiency.

Billing Considerations

Considerations include the age of the patient, the timing of diagnosis, and the impact on growth and development.

Genetics

Documentation Requirements

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

Common Clinical Scenarios

Scenarios may involve genetic counseling for families with a history of congenital malformations.

Billing Considerations

Considerations include the potential for chromosomal abnormalities that may be associated with pancreatic malformations.

Coding Guidelines

Inclusion Criteria

Use Q45.3 When
  • Follow official coding guidelines for congenital conditions, ensuring accurate documentation of the malformation type, associated symptoms, and any surgical interventions

Exclusion Criteria

Do NOT use Q45.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

47562CPT Code

Laparoscopic cholecystectomy

Clinical Scenario

Used in cases where pancreatic malformations lead to gallbladder complications.

Documentation Requirements

Document indications for surgery and any pre-existing conditions.

Specialty Considerations

Considerations for pediatric patients include age-appropriate surgical risks.

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

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common symptoms of congenital pancreatic malformations?

Common symptoms include failure to thrive, abdominal pain, and signs of malabsorption such as diarrhea or nutritional deficiencies. Early diagnosis and management are crucial for improving outcomes.