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v1.0.0
ICD-10 Guide
ICD-10 CodesQ83.0

Q83.0

Billable

Congenital absence of breast with absent nipple

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

Code Description

ICD-10 Q83.0 is a billable code used to indicate a diagnosis of congenital absence of breast with absent nipple.

Key Diagnostic Point:

Congenital absence of breast with absent nipple is a rare condition characterized by the complete absence of breast tissue and nipple formation. This anomaly can occur unilaterally or bilaterally and may be associated with other congenital malformations. The condition is often diagnosed at birth or during early childhood when breast development is expected. The absence of breast tissue can lead to psychological and social implications as the individual matures. It is essential to evaluate for associated anomalies, particularly in syndromic presentations, where other congenital defects may be present. The condition may be linked to genetic factors, and genetic counseling is recommended for affected families. Management may involve surgical options for reconstruction, particularly in adolescents and adults seeking aesthetic correction. Accurate coding is crucial for appropriate treatment planning and insurance reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation (unilateral vs bilateral absence)
  • Potential association with other congenital anomalies
  • Need for multidisciplinary management (surgery, psychology)
  • Documentation of family history and genetic counseling

Audit Risk Factors

  • Inadequate documentation of associated anomalies
  • Failure to document family history or genetic counseling
  • Misclassification of congenital vs acquired conditions
  • Lack of clarity in the clinical scenario leading to coding errors

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed pediatric history, including prenatal factors and family history of congenital conditions.

Common Clinical Scenarios

Evaluation of newborns with absent breast tissue during routine examinations or referrals for developmental concerns.

Billing Considerations

Consideration of psychosocial impacts and the need for potential reconstructive surgery as the child matures.

Genetics

Documentation Requirements

Genetic testing results, family pedigree, and any syndromic associations.

Common Clinical Scenarios

Referral for genetic counseling when congenital absence is part of a syndrome or when there is a family history of congenital anomalies.

Billing Considerations

Understanding the genetic basis and implications for family planning and recurrence risk.

Coding Guidelines

Inclusion Criteria

Use Q83.0 When
  • Follow ICD
  • CM guidelines for coding congenital conditions, ensuring accurate documentation of the absence of breast and nipple, and any associated congenital anomalies
  • Use additional codes as necessary to capture related conditions

Exclusion Criteria

Do NOT use Q83.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

19316CPT Code

Breast reconstruction

Clinical Scenario

Used for patients seeking surgical correction of congenital breast absence.

Documentation Requirements

Document the indication for surgery, including psychological impact and physical examination findings.

Specialty Considerations

Plastic surgery may require additional documentation regarding aesthetic concerns.

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 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 conditions, 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 implications of coding Q83.0?

Coding Q83.0 accurately reflects the congenital absence of breast and nipple, which is crucial for appropriate management and potential surgical interventions. It also aids in understanding the patient's overall health and any associated congenital conditions.