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v1.0.0
ICD-10 Guide
ICD-10 CodesQ74.1

Q74.1

Billable

Congenital malformation of knee

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

Code Description

ICD-10 Q74.1 is a billable code used to indicate a diagnosis of congenital malformation of knee.

Key Diagnostic Point:

Congenital malformation of the knee refers to a variety of structural abnormalities present at birth that affect the knee joint and surrounding tissues. These malformations can include conditions such as knee dislocation, hypoplasia (underdevelopment) of the knee joint, or other deformities that may impact the function and appearance of the knee. These conditions can arise from genetic factors, environmental influences, or a combination of both. The knee malformations can lead to functional limitations, pain, and may require surgical intervention or physical therapy for management. Early diagnosis and intervention are crucial for optimizing outcomes and ensuring proper development of the musculoskeletal system. In pediatric patients, these malformations may be associated with other congenital anomalies, necessitating a comprehensive evaluation to identify any coexisting conditions. The management of congenital knee malformations often involves a multidisciplinary approach, including orthopedic specialists, physical therapists, and genetic counselors, to address the complex needs of affected children.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of knee malformations
  • Potential association with other congenital anomalies
  • Need for detailed documentation of clinical findings
  • Differentiation from acquired conditions

Audit Risk Factors

  • Inadequate documentation of the specific type of malformation
  • Failure to document associated congenital conditions
  • Misclassification of congenital malformations as acquired
  • Lack of clarity in treatment plans and outcomes

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes describing the malformation, associated symptoms, and treatment plans are essential. Growth and developmental assessments should be included.

Common Clinical Scenarios

A pediatric patient presenting with knee instability or deformity, requiring orthopedic evaluation and potential surgical intervention.

Billing Considerations

Consideration of the child's overall development and any associated musculoskeletal or systemic conditions is crucial for accurate coding.

Genetics

Documentation Requirements

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

Common Clinical Scenarios

A child with a congenital knee malformation undergoing genetic counseling to assess for syndromic associations.

Billing Considerations

Understanding the genetic basis of congenital malformations can aid in prognosis and management, necessitating thorough documentation.

Coding Guidelines

Inclusion Criteria

Use Q74.1 When
  • Follow the official ICD
  • CM guidelines for coding congenital malformations, ensuring specificity in documentation and coding based on clinical findings and treatment plans

Exclusion Criteria

Do NOT use Q74.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27500CPT Code

Knee arthroplasty

Clinical Scenario

Used in cases of severe congenital knee malformation requiring surgical intervention.

Documentation Requirements

Detailed operative notes and pre-operative assessments.

Specialty Considerations

Orthopedic specialists should ensure accurate coding based on the specific procedure performed.

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 ability to capture the complexity of these conditions and their management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the ability to capture the complexity of these conditions and their management.

Reimbursement & Billing Impact

reimbursement.

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 documentation is required for coding Q74.1?

Documentation should include a detailed description of the knee malformation, associated symptoms, treatment plans, and any relevant imaging or genetic testing results.