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ICD-10 Guide
ICD-10 CodesChapter 17: Congenital malformations and chromosomal abnormalitiesQ91

Q91

Non-billable

Trisomy 18 and Trisomy 13

Chapter 17:Congenital malformations and chromosomal abnormalities

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 Q91 is a used to indicate a diagnosis of trisomy 18 and trisomy 13.

Key Diagnostic Point:

The ICD-10 Level 1 Category code Q91 encompasses conditions related to Trisomy 18 and Trisomy 13, both of which are chromosomal disorders resulting from the presence of an extra chromosome 18 or 13, respectively. These conditions are characterized by severe developmental delays, congenital anomalies, and a high rate of mortality in infancy. Trisomy 18, also known as Edwards syndrome, is associated with a range of physical abnormalities including low birth weight, heart defects, and organ malformations. Trisomy 13, or Patau syndrome, presents with similar challenges, including cleft lip and palate, polydactyly, and neurological impairments. The clinical significance of these conditions lies in their profound impact on the affected individuals and their families, necessitating comprehensive medical care and support.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation
  • Need for genetic testing
  • Multidisciplinary care requirements

Audit Risk Factors

  • Inadequate documentation of genetic testing
  • Failure to specify the type of trisomy
  • Misclassification of severity of associated conditions

Specialty Focus

Medical Specialties

Genetics

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Pediatrics

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical and administrative impact of the Q91 code category is significant, as it not only affects the quality of care provided to patients with Trisomy 18 and Trisomy 13 but also influences population health metrics. Accurate coding and documentation can lead to better tracking of these rare conditions, facilitating research and improving health outcomes. Additionally, awareness of these conditions can drive healthcare trends towards more comprehensive prenatal screening and genetic counseling, ultimately enhancing the support available for affected families.

ICD-9 vs ICD-10

The clinical and administrative impact of the Q91 code category is significant, as it not only affects the quality of care provided to patients with Trisomy 18 and Trisomy 13 but also influences population health metrics. Accurate coding and documentation can lead to better tracking of these rare conditions, facilitating research and improving health outcomes. Additionally, awareness of these conditions can drive healthcare trends towards more comprehensive prenatal screening and genetic counseling, ultimately enhancing the support available for affected families.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, but generally, comprehensive documentation that supports the medical necessity of services is crucial. Providers should ensure that all relevant clinical information is included in the billing claims to avoid denials and ensure appropriate reimbursement for the complex care often required by patients with these conditions.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for Q91

Coding & Billing References

  • •
    Official ICD-10 Guidelines for Q91

Frequently Asked Questions

What conditions are included in Q91?

Q91 includes Trisomy 18 (Edwards syndrome) and Trisomy 13 (Patau syndrome), both of which are characterized by the presence of an extra chromosome leading to significant developmental and physical challenges.

When should I use Q91 codes?

Q91 codes should be used when diagnosing patients with confirmed Trisomy 18 or Trisomy 13, particularly when there are associated congenital anomalies or developmental delays that require specialized medical attention.

What documentation is required for Q91?

Documentation for Q91 should include genetic testing results confirming the diagnosis of Trisomy 18 or Trisomy 13, detailed clinical findings, and any associated conditions or anomalies observed in the patient.