ICD-10 Coding for Neurofibromatosis(Q85.01, Q85.02)
Complete ICD-10-CM coding and documentation guide for Neurofibromatosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Neurofibromatosis
Q85.0-Q85.9Primary Range
Phakomatoses, not elsewhere classified
This range includes codes for neurofibromatosis types 1 and 2, which are the primary conditions discussed.
Benign neoplasm of brain and other parts of central nervous system
Includes codes for benign tumors like optic gliomas, which are common in NF1.
Benign neoplasm of other and unspecified sites
Includes codes for plexiform neurofibromas, which are associated with NF1.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Q85.01 | Neurofibromatosis, type 1 | Use when NF1 is confirmed by clinical criteria or genetic testing. |
|
| Q85.02 | Neurofibromatosis, type 2 | Use when NF2 is confirmed by clinical criteria or genetic testing. |
|
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 neurofibromatosis
Essential facts and insights about Neurofibromatosis
Primary ICD-10-CM Codes for neurofibromatosis
Decision Criteria
clinical Criteria
- Presence of two or more NIH criteria for NF1.
Applicable To
- Von Recklinghausen's disease
Excludes
- Neurofibromatosis, type 2 (Q85.02)
Clinical Validation Requirements
- Six or more café-au-lait macules
- Two or more neurofibromas or one plexiform neurofibroma
- Axillary or inguinal freckling
- Optic glioma
- Two or more Lisch nodules
Code-Specific Risks
- Misclassification if clinical criteria are not fully documented.
Coding Notes
- Ensure all NIH criteria are documented to support the use of this code.
Q85.02 - Neurofibromatosis, type 2
Use when NF2 is confirmed by clinical criteria or genetic testing.
Applicable To
- Bilateral vestibular schwannomas
Excludes
- Neurofibromatosis, type 1 (Q85.01)
Clinical Validation Requirements
- Bilateral vestibular schwannomas
- Family history of NF2
- Meningiomas or ependymomas
Coding Notes
Document genetic testing results if available to support NF2 diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Neurofibromatosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Q85.01.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims or audits.
Mitigation Strategy
Use specific clinical criteria in documentation., Ensure all relevant findings are recorded.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Ensure specific criteria for NF1 or NF2 are documented and use Q85.01 or Q85.02 accordingly.
Impact
High risk of audit if unspecified codes are used without justification.
Mitigation Strategy
Always document specific criteria and use the most specific code available.
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 Neurofibromatosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Neurofibromatosis
Use these documentation templates to ensure complete and accurate documentation for Neurofibromatosis. These templates include all required elements for proper coding and billing.
NF1 with optic glioma
Specialty: NeurologyRequired Elements
- Clinical criteria for NF1
- Imaging results for optic glioma
- Genetic testing results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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