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ICD-10 Guide
ICD-10 CodesChapter 17: Congenital malformations and chromosomal abnormalitiesQ86

Q86

Billable

Congenital malformation syndromes due to known exogenous causes, not elsewhere classified

Chapter 17:Congenital malformations and chromosomal abnormalities

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

Code Description

ICD-10 Q86 is a billable code used to indicate a diagnosis of congenital malformation syndromes due to known exogenous causes, not elsewhere classified.

Key Diagnostic Point:

Congenital malformation syndromes classified under Q86 encompass a variety of conditions resulting from known exogenous factors, such as teratogenic exposures during pregnancy. These syndromes can lead to a range of congenital malformations affecting various organ systems, including skin, breast, spleen, and adrenal glands. For instance, congenital skin conditions may include epidermolysis bullosa or congenital nevi, while breast malformations can manifest as Poland syndrome. Spleen and adrenal gland anomalies may present as asplenia or congenital adrenal hyperplasia, respectively. The complexity of these syndromes often arises from the interplay of genetic predispositions and environmental factors, necessitating thorough clinical evaluation and documentation. Accurate coding requires an understanding of the specific malformations and their associations with known teratogens, as well as the implications for patient management and genetic counseling.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of congenital conditions under this code
  • Need for detailed documentation of exogenous factors
  • Potential overlap with other congenital codes
  • Variability in clinical presentation

Audit Risk Factors

  • Inadequate documentation of exogenous factors
  • Misclassification of congenital conditions
  • Failure to specify associated anomalies
  • Lack of interdisciplinary notes in the medical record

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include detailed prenatal history, family history, and specific congenital anomalies observed.

Common Clinical Scenarios

Common scenarios include infants presenting with multiple congenital anomalies, requiring a thorough evaluation of potential teratogenic exposures.

Billing Considerations

Consideration must be given to the age of the patient and the developmental implications of the congenital malformations.

Genetics

Documentation Requirements

Genetic documentation should include family pedigree, genetic testing results, and any known environmental exposures during pregnancy.

Common Clinical Scenarios

Scenarios often involve genetic counseling for families with a history of congenital malformations due to known teratogens.

Billing Considerations

Geneticists must differentiate between syndromes caused by genetic versus environmental factors, which can impact coding.

Coding Guidelines

Inclusion Criteria

Use Q86 When
  • Official coding guidelines emphasize the importance of documenting the specific exogenous factors contributing to congenital malformations, as well as any associated conditions that may influence treatment and management

Exclusion Criteria

Do NOT use Q86 When
No specific exclusions found.

Related CPT Codes

99213CPT Code

Established patient office visit

Clinical Scenario

Used for follow-up visits for children with congenital malformations.

Documentation Requirements

Documentation must include a review of systems and assessment of the congenital condition.

Specialty Considerations

Pediatricians should ensure that all aspects of the child's health are addressed during visits.

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 nuances of conditions like those classified under Q86, which can lead to better patient management and research opportunities.

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 nuances of conditions like those classified under Q86, which can lead to better patient management and research opportunities.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the ability to capture the nuances of conditions like those classified under Q86, which can lead to better patient management and research opportunities.

Resources

Clinical References

  • •
    CDC Birth Defects

Coding & Billing References

  • •
    CDC Birth Defects

Frequently Asked Questions

What are the common exogenous causes of congenital malformations?

Common exogenous causes include maternal drug use, infections during pregnancy (such as rubella), exposure to environmental toxins, and nutritional deficiencies. Each of these factors can lead to specific congenital anomalies, necessitating careful documentation and coding.