ICD-10 Coding for Congenital Hypertrophy of Retinal Pigment Epithelium(Q14.1, D12.6)
Complete ICD-10-CM coding and documentation guide for Congenital Hypertrophy of Retinal Pigment Epithelium. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Congenital Hypertrophy of Retinal Pigment Epithelium
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Q14.1 | Congenital malformation of retina | Use for any presentation of CHRPE unless specifically linked to FAP. |
|
| D12.6 | Adenomatous polyposis of colon | Use when CHRPE is part of a clinical picture of FAP. |
|
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 CHRPE
Essential facts and insights about Congenital Hypertrophy of Retinal Pigment Epithelium
Primary ICD-10-CM Codes for chrpe
Decision Criteria
clinical Criteria
- Presence of pigmented retinal lesions with typical CHRPE appearance
documentation Criteria
- Detailed description of lesion characteristics and any family history of FAP
Applicable To
- Solitary CHRPE
- Atypical CHRPE
Excludes
- Retinal neoplasms
Clinical Validation Requirements
- Fundoscopic exam showing pigmented retinal lesions
- Documentation of lesion characteristics (e.g., unilateral, bilateral)
Code-Specific Risks
- Misclassification as a neoplasm
- Omission of FAP association when present
Coding Notes
- Ensure documentation specifies lesion characteristics and any genetic testing results.
D12.6 - Adenomatous polyposis of colon
Use when CHRPE is part of a clinical picture of FAP.
Applicable To
- Familial Adenomatous Polyposis
Excludes
- Non-adenomatous polyps
Clinical Validation Requirements
- Genetic testing confirming APC mutation
- Colonoscopy findings of multiple adenomatous polyps
Coding Notes
Sequence D12.6 first if the encounter is primarily for FAP management.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Congenital Hypertrophy of Retinal Pigment Epithelium to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Q14.1.
Impact
Clinical: Missed opportunity for genetic counseling, Regulatory: Non-compliance with hereditary condition documentation, Financial: Potential loss of reimbursement for related services
Mitigation Strategy
Always inquire about family history during patient intake
Impact
Reimbursement: Potential underpayment due to incomplete coding, Compliance: Non-compliance with coding guidelines for hereditary conditions, Data Quality: Inaccurate representation of patient's clinical picture
Mitigation Strategy
Include D12.6 when CHRPE is associated with FAP.
Impact
Failure to include all relevant codes for conditions like FAP.
Mitigation Strategy
Implement regular training on hereditary condition 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 Congenital Hypertrophy of Retinal Pigment Epithelium, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Congenital Hypertrophy of Retinal Pigment Epithelium
Use these documentation templates to ensure complete and accurate documentation for Congenital Hypertrophy of Retinal Pigment Epithelium. These templates include all required elements for proper coding and billing.
Ophthalmology examination for CHRPE
Specialty: OphthalmologyRequired Elements
- Lesion characteristics
- Family history
- Genetic testing results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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