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ICD-10 Guide
ICD-10 CodesChapter 17: Congenital malformations and chromosomal abnormalitiesQ87

Q87

Billable

Other specified congenital malformation syndromes affecting multiple systems

Chapter 17:Congenital malformations and chromosomal abnormalities

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

Code Description

ICD-10 Q87 is a billable code used to indicate a diagnosis of other specified congenital malformation syndromes affecting multiple systems.

Key Diagnostic Point:

Congenital malformation syndromes affecting multiple systems can present a complex array of clinical features that may involve various organ systems, including the skin, breast, spleen, and adrenal glands. These syndromes often arise from genetic mutations or environmental factors during fetal development. Conditions such as ectodermal dysplasia, which affects skin and hair, or congenital adrenal hyperplasia, which impacts adrenal gland function, exemplify the diversity of manifestations. Patients may exhibit a combination of physical anomalies, functional impairments, and developmental delays. Accurate diagnosis often requires a multidisciplinary approach, including genetic testing, imaging studies, and clinical evaluations. The complexity of these syndromes necessitates thorough documentation to capture the full spectrum of associated anomalies and their implications for treatment and management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of associated anomalies across multiple systems
  • Need for detailed clinical documentation
  • Potential for overlapping syndromes
  • Variability in presentation and severity

Audit Risk Factors

  • Inadequate documentation of associated anomalies
  • Failure to specify the exact syndrome
  • Misclassification of syndromes with overlapping features
  • Lack of genetic testing results in the medical record

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation must include growth parameters, developmental milestones, and specific physical findings related to congenital anomalies.

Common Clinical Scenarios

Common scenarios include newborns with multiple congenital anomalies requiring multidisciplinary care and follow-up.

Billing Considerations

Considerations include the need for ongoing developmental assessments and coordination of care among specialists.

Genetics

Documentation Requirements

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

Common Clinical Scenarios

Scenarios often involve genetic counseling for families with a history of congenital anomalies or syndromes.

Billing Considerations

Genetic coding requires precise identification of syndromes and understanding of inheritance patterns.

Coding Guidelines

Inclusion Criteria

Use Q87 When
  • Official coding guidelines emphasize the importance of specificity in documenting congenital conditions, including the need for detailed descriptions of anomalies and their impact on health

Exclusion Criteria

Do NOT use Q87 When
No specific exclusions found.

Related CPT Codes

81228CPT Code

Genetic testing for congenital anomalies

Clinical Scenario

Used in conjunction with Q87 for confirming genetic syndromes.

Documentation Requirements

Documentation of clinical indications for testing and results.

Specialty Considerations

Genetic specialists must ensure accurate coding based on test results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    CDC Congenital Malformations

Coding & Billing References

  • •
    CDC Congenital Malformations

Frequently Asked Questions

What documentation is required for coding Q87?

Documentation must include a detailed description of the congenital anomalies, any genetic testing results, and the clinical implications of the condition. It is essential to specify the associated systems affected and any treatments or interventions planned.