ICD-10 Coding for Prader-Willi Syndrome(Q87.11)
Complete ICD-10-CM coding and documentation guide for Prader-Willi Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Prader-Willi Syndrome
Q87.1-Q87.11Primary Range
Congenital malformation syndromes predominantly associated with short stature
Q87.11 is specifically for Prader-Willi Syndrome, distinguishing it from other genetic disorders in the same range.
Key Information: ICD-10 code for Prader-Willi Syndrome
Essential facts and insights about Prader-Willi Syndrome
Primary ICD-10-CM Code for prader willi syndrome
Decision Criteria
clinical Criteria
- Genetic confirmation of PWS through methylation analysis or FISH.
documentation Criteria
- Detailed documentation of clinical features and genetic test results.
Applicable To
- Prader-Willi syndrome confirmed by genetic testing
Clinical Validation Requirements
- Genetic testing confirming paternal deletion or maternal UPD of chromosome 15
- Clinical features such as hypotonia, hyperphagia, and developmental delays
Code-Specific Risks
- Incorrectly coding as Q87.1 without genetic confirmation
- Failing to document associated comorbidities
Coding Notes
- Ensure genetic confirmation is documented before coding Q87.11.
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 Prader-Willi Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Q87.11.
Impact
Clinical: Misdiagnosis or delayed treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure detailed genetic and clinical documentation., Regular training on documentation standards.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data collection for research and statistics.
Mitigation Strategy
Ensure genetic confirmation is documented and use Q87.11.
Impact
Lack of detailed genetic test results in patient records.
Mitigation Strategy
Ensure all genetic tests are documented with results and interpretations.
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 Prader-Willi Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Prader-Willi Syndrome
Use these documentation templates to ensure complete and accurate documentation for Prader-Willi Syndrome. These templates include all required elements for proper coding and billing.
Initial Diagnosis of PWS
Specialty: GeneticsRequired Elements
- Genetic test results
- Clinical features
- Family history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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