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ICD-10 Coding for Absence of Appendix(Q43.0, Z90.89)

Complete ICD-10-CM coding and documentation guide for Absence of Appendix. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Appendix MissingAppendix Absent

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Related ICD-10 Code Ranges

Complete code families applicable to Absence of Appendix

Q43.0Primary Range

Congenital absence, atresia and stenosis of large intestine

This range includes congenital absence of the appendix, which is a primary condition of interest.

Z90.89

Acquired absence of other specified organs

This range includes acquired absence of the appendix, typically post-surgical.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
Q43.0Congenital absence of appendixUse when congenital absence is confirmed by prenatal imaging and there is no surgical history.
  • Prenatal ultrasound findings
  • No surgical history
  • Associated intestinal malformations
Z90.89Acquired absence of other specified organsUse when absence is due to surgical removal, confirmed by operative reports.
  • Operative report available
  • Scar documentation
  • Post-op complications requiring coding

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for congenital absence of appendix

Essential facts and insights about Absence of Appendix

The ICD-10 code for congenital absence of the appendix is Q43.0, used when confirmed by prenatal imaging.

Primary ICD-10-CM Codes for absence of appendix

Q43.0
Congenital absence of appendix
Billable Code

Decision Criteria

clinical Criteria

  • Confirmed congenital absence via imaging

documentation Criteria

  • No history of appendectomy

Applicable To

  • Congenital absence of appendix

Excludes

  • Acquired absence of appendix (Z90.89)

Clinical Validation Requirements

  • Prenatal ultrasound findings
  • No surgical history
  • Associated intestinal malformations

Code-Specific Risks

  • Misclassification if surgical history is not reviewed.

Coding Notes

  • Ensure congenital absence is confirmed through imaging and not confused with surgical removal.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Acute appendicitis with perforation

K35.2
Use if appendicitis history is relevant to current care.

Post-procedural states

Z98.89
Use if appendectomy impacts current treatment.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Acquired absence of appendix

Z90.89
Use Z90.89 if the absence is due to surgical removal.

Congenital absence of appendix

Q43.0
Use Q43.0 if absence is congenital and not due to surgery.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Absence of Appendix to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Q43.0.

Impact

Clinical: Misleading clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.

Mitigation Strategy

Require imaging confirmation, Verify surgical history

Impact

Reimbursement: Incorrect DRG assignment may occur., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate patient records.

Mitigation Strategy

Ensure prenatal imaging confirms absence before coding as congenital.

Impact

Reimbursement: Potential denial of claims., Compliance: Failure to meet documentation standards., Data Quality: Misleading patient history.

Mitigation Strategy

Verify operative reports before coding Z90.89.

Impact

Risk of coding congenital absence without proper imaging confirmation.

Mitigation Strategy

Implement mandatory imaging review for congenital absence coding.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Absence of Appendix, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Absence of Appendix

Use these documentation templates to ensure complete and accurate documentation for Absence of Appendix. These templates include all required elements for proper coding and billing.

Post-Appendectomy Follow-Up

Specialty: General Surgery

Required Elements

  • Operative report
  • Scar documentation
  • Post-op complications

Example Documentation

Assessment: Acquired absence of appendix (Z90.89). Status post laparoscopic appendectomy (10/15/2022). No evidence of appendiceal stump on ultrasound.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Appendix not visualized during procedure.
Good Documentation Example
Laparoscopic confirmation of complete appendiceal absence secondary to appendectomy performed 2012 (see op report). No residual stump identified.
Explanation
The good example provides specific surgical history and confirmation of absence.

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