Tetralogy of Fallot ICD-10 CM coding guide for coder

Jitendra M.Sc CPC

Basics of Tetralogy of Fallot ICD-10 CM coding

Tetralogy of Fallot (pronounced te-tral-uh-jee of Fal-oh) is a birth defect that affects normal blood flow through the heart. It happens when a baby’s heart does not form correctly as the baby grows and develops in the mother’s womb during pregnancy.

ICD-10 code Q21. 3 for Tetralogy of Fallot is a medical classification as listed by WHO under the range – Congenital malformations, deformations and chromosomal abnormalities .

Q21.3 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

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Signs and Symptoms | Tetralogy of Fallot ICD-10 CM coding

Symptoms of Tetralogy of Fallot include the following:

  • Low blood oxygenation from birth or developing sometime in the first year
  • Cyanosis
  • Heart murmur
  • Failure to gain weight
  • Retarded growth/physical development
  • Clubbing of digits
  • Polycythemia
  • Dyspnea on exertion
  • Difficulty feeding

Treatment |Tetralogy of Fallot ICD-10 CM coding

Echocardiography is most commonly used to diagnose the condition, although chest X-rays can often confirm the condition’s presence.

Treatment can include the following:

Documentation and  Tetralogy of Fallot ICD-10 CM coding

For inpatient coding Tetralogy of Fallot can be an MCC

The diagnosis of Tetralogy of Fallot is reported with ICD-10-CM code Q21.3 (Tetralogy of Fallot). Codes in subcategory Q21.- (congenital malformations of cardiac septa) have an Excludes1 note of I51.0 (acquired cardiac septal defect). Additionally, codes in Chapter 17 (Q00-Q99) have Excludes2 notes of E70-E88 (inborn errors of metabolism). 

Excludes1 notes indicate which codes should never be reported together, while Excludes2 notes show which codes can be reported together, given the proper specificity and documentation. 

CPT

Repair of Tetralogy of Fallot is reported with CPT codes: 

  • 33692, complete repair Tetralogy of Fallot without pulmonary atresia
  • 33694, complete repair Tetralogy of Fallot without pulmonary atresia; with transannular patch
  • 33697, complete repair Tetralogy of Fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect

Related Synonyms

  • Dextraposition of aorta in fallot’s tetralogy
  • Dextroposition of aorta in tetralogy of fallot
  • Tetralogy of fallot with absent pulmonary valve
  • Tetralogy of fallot with pulmonary atresia
  • Tetralogy of fallot with pulmonary stenosis
  • Tetralogy of fallot with ventricular septal defect
  • Ventricular septal defect in fallot’s tetralogy

 

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