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ICD-10 Guide
ICD-10 CodesQ82.5

Q82.5

Billable

Congenital non-neoplastic nevus

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

Code Description

ICD-10 Q82.5 is a billable code used to indicate a diagnosis of congenital non-neoplastic nevus.

Key Diagnostic Point:

Congenital non-neoplastic nevi are benign skin lesions that are present at birth or develop shortly thereafter. These nevi can vary in size, shape, and color, and they may be flat or raised. They are typically composed of an abnormal proliferation of melanocytes, which are the cells responsible for pigment production in the skin. While most congenital nevi are harmless, larger lesions may carry a risk of malignant transformation, particularly if they exceed a certain size. Clinical evaluation often involves monitoring for changes in size, color, or texture, which may indicate the need for further investigation or intervention. In pediatric patients, these lesions can be a source of parental concern, necessitating thorough counseling and education regarding their benign nature and management options. Documentation should include the size, location, and characteristics of the nevus, as well as any associated symptoms or changes over time.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and size of nevi
  • Potential for malignant transformation in larger lesions
  • Need for ongoing monitoring and documentation of changes
  • Differentiation from other skin lesions

Audit Risk Factors

  • Inadequate documentation of nevus characteristics
  • Failure to document monitoring or follow-up visits
  • Misclassification of nevi as neoplastic
  • Inconsistent coding of associated conditions

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include detailed descriptions of the nevus, including size, location, and any changes observed over time. Family history and parental concerns should also be documented.

Common Clinical Scenarios

Common scenarios include routine monitoring of congenital nevi during well-child visits and referrals for surgical evaluation if changes are noted.

Billing Considerations

Considerations include the psychological impact on families and the importance of educating parents about the benign nature of most congenital nevi.

Genetics

Documentation Requirements

Genetic documentation may include family history of skin lesions, syndromic associations, and any genetic testing results that may relate to the nevus.

Common Clinical Scenarios

Scenarios may involve genetic counseling for families with multiple congenital nevi or those with syndromic presentations.

Billing Considerations

Considerations include the potential for genetic syndromes associated with multiple nevi, such as neurocutaneous syndromes.

Coding Guidelines

Inclusion Criteria

Use Q82.5 When
  • 10 coding guidelines for congenital conditions emphasize the importance of specificity in documentation, including the size and characteristics of the nevus, as well as any associated symptoms or conditions

Exclusion Criteria

Do NOT use Q82.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

11400CPT Code

Excision, benign lesion including margins

Clinical Scenario

Used when a congenital nevus is excised for cosmetic or medical reasons.

Documentation Requirements

Documentation should include the reason for excision and details of the nevus.

Specialty Considerations

Pediatric considerations include the impact of the lesion on the child's quality of life.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the ability to track and manage congenital nevi and their associated risks.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the ability to track and manage congenital nevi and their associated risks.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the ability to track and manage congenital nevi and their associated risks.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Congenital Nevi

Coding & Billing References

  • •
    American Academy of Pediatrics - Congenital Nevi

Frequently Asked Questions

What is the difference between congenital and acquired nevi?

Congenital nevi are present at birth or develop shortly thereafter, while acquired nevi develop later in life. Accurate coding requires clear documentation to differentiate between the two.