Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 20: Congenital Malformation, Deformations and Chromosomal Abnormalities (Q00–Q99)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of congenital malformations, deformations and chromosomal abnormalities?

3. ICD-10-CM Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00–Q99) Conditions have been organized to better identify the type of conditions classified to chapter 17 Terminology has been updated to reflect current medical practice and includes greater specificity to describe the patient’s condition

4. ICD-10-CM Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00–Q99) Codes in Chapter 17 are arranged in the following blocks: Q00–Q07 Congenital malformations of the nervous system Q10–Q18 Congenital malformations of the eye, ear, face and neck Q20–Q28 Congenital malformations of the circulatory system Q30–Q34 Congenital malformations of the respiratory system Q35–Q37 Cleft lip and cleft palate Q38–Q45 Other congenital malformations of the digestive system

5. ICD-10-CM Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00–Q99) Codes in Chapter 17 are arranged in the following blocks (continued): Q50–Q56 Congenital malformations of genital organs Q60–Q64 Congenital malformations of the urinary system Q65–Q79 Congenital malformations and deformations of the musculoskeletal system Q80–Q89 Other congenital malformations Q90–Q99 Chromosomal abnormalities, not elsewhere classified

6. ICD-10-CM Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00–Q99) Congenital anomaly Malformation or deformation that is present at or existing from the time of birth Chromosome abnormality Irregularity in the number or structure of chromosomes that may alter the course of the development of the embryo

7. ICD-10-CM Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00–Q99) Chapter organized by body system Organized into subcategories to identify the type of condition Codes provide specificity according to the anatomic site and the combination of congenital conditions

8. Coding Instructional Notes for ICD-10-CM Chapter 17 When an infant is born with a congenital anomaly, an appropriate code from Chapter 17 of ICD-10-CM should be used on the infant’s record following the code from category Z38 to identify the place of birth and type of delivery When an infant is transferred to another hospital for care of the congenital condition, the principal diagnosis at the second hospital would be the congenital condition and the Z38 code is not assigned

9. Coding Instructional Notes for ICD-10-CM Chapter 17 Instructions are included to direct the coder when additional codes are required, for example, use additional code for associated paraplegia or associated glaucoma When a congenital condition does not have a unique code assignment, the coder should assign additional code(s) for any manifestations that may be present Review the note under category Q87 For chromosomal abnormalities, a note appears to use additional codes to identify any associate physical condition or the degree of intellectual disabilities that are present

10. Coding Guidelines for ICD-10-CM Chapter 17 NCHS has published chapter-specific guidelines for Chapter 17 in the ICD-10-CM Official Guidelines for Coding and Reporting Assign chapter 17 code when abnormality is documented Code may be the principal/first-listed or a secondary diagnosis code When condition does not have unique code, assign additional code(s) for any manifestation present

11. Coding Guidelines for ICD-10-CM Chapter 17 NCHS has published chapter-specific guidelines for Chapter 17 in the ICD-10-CM Official Guidelines for Coding and Reporting (continued) Manifestations that are an inherent component of the anomaly should not be coded separately Additional codes are assigned for manifestations that are not an inherent component of an anomaly Codes can be used throughout the life of the patient Personal history codes used when no longer present

12. Coding Conditions in ICD-10-CM Chapter 17 Central Nervous System Defects Involve the brain, spinal cord and associated tissue Include neural tube defects (anencephaly, spina bifida and encephalocele), microcephalous and hydrocephalus Common CNS defect is spina bifida which is a defective closure of the vertebral column Most types coded to category Q05, with 4th digit subcategories to describe the site with presence or absence of hydrocephalus

13. Coding Conditions in ICD-10-CM Chapter 17 Cardiovascular System Defects Involve the heart and circulatory system Most common group of birth defects in infants Surgical procedures repair defects and restore circulation to as normal as possible More commonly occur are patent ductus arteriosus, atrial septal defect, ventricular septal defect and pulmonary artery anomalies

14. Coding Conditions in ICD-10-CM Chapter 17 Respiratory System Defects Involve the lungs, trachea, and nose Less common group of defects Lung hypoplasia or dysplasia is a failure to develop or underdevelopment of one or both lungs Respiratory anomalies require immediate medical and surgical care to correct it so that the infant regains adequate respiratory function

15. Coding Conditions in ICD-10-CM Chapter 17 Digestive System Defects Orofacial and gastrointestinal defects Cleft lip and cleft palate or combination of both Cleft lip codes are subdivided to identify bilateral, median or unilateral forms Cleft palate codes are identified as hard palate or soft palate When both exist, codes identify which palate is involved and whether cleft lip is bilateral or unilateral type Pyloric stenosis is narrowing of the outlet between the stomach and the small intestine; identified soon after birth

16. Coding Conditions in ICD-10-CM Chapter 17 Genitourinary Tract Defects Affects both males and female; some are relatively minor and fairly common defects that can be repaired by surgery. Some of these defects are: Mullerian anomalies of the uterus Bladder exstrophy Epispadias and hypospadias Obstructive genitourinary defects Renal agenesis or hypoplasia Cystic or polycystitic kidney disease

17. Coding Conditions in ICD-10-CM Chapter 17 Musculoskeletal Defects Relatively common and range from minor problems to more serious conditions. The most common musculoskeletal anomaly is clubfoot that includes Varus deformities or inward turning of the feet Valgus deformities or outward turning of the feet Talipes cavus or increased arch of foot Talipes calcaneous or equinus or an abnormal upward or downward misalignment

18. Coding Conditions in ICD-10-CM Chapter 17 Chromosomal Defects Abnormal numbers of chromosomes or defects in specific fragments of the chromosomes Each disorder is associated with a characteristic pattern of defects The more common chromosomal conditions include: Down syndrome associated with the presence of a third number 21 chromosome. Also known as Trisomy 21 Edward’s syndrome is associated with the presence of a third number 18 chromosome. Also known as Trisomy 18 Patau’s syndrome is associated with the presence of a third number 13 chromosome. Also known as Trisomy 13

19. ICD-10-PCS Procedure Coding to Correct Congenital Malformations and Deformations Surgical procedures to correct congenital malformations, deformations or congenital anomalies are based on the objective of the procedure Hydrocephalus treated with the creation of a shunt Spina bifida requires surgical closure of the defect Surgical repair of cleft lips and/or palate Pyloric stenosis usually requires dividing the muscular band of tissue in the stomach or another form of pyloroplasty

20. Exercises Practice coding the conditions included in Chapter 17 of ICD-10-CM for congenital malformations, deformations and chromosomal abnormalities as well as the procedures used to treat these conditions by completing the review exercises for Chapter 20.