ICD-10 Coding for Tetralogy of Fallot(Q21.3, Q22.0)
Complete ICD-10-CM coding and documentation guide for Tetralogy of Fallot. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tetralogy of Fallot
Q20-Q28Primary Range
Congenital malformations of the circulatory system
This range includes all congenital heart defects, including Tetralogy of Fallot.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Q21.3 | Tetralogy of Fallot | Use when all four anatomical defects of TOF are present. |
|
| Q22.0 | Pulmonary valve atresia | Use when TOF is present with pulmonary valve atresia. |
|
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 Tetralogy of Fallot
Essential facts and insights about Tetralogy of Fallot
Primary ICD-10-CM Codes for tetralogy of fallot
Decision Criteria
clinical Criteria
- Presence of all four TOF defects
coding Criteria
- Avoid using Q21.82 for pentalogy
Applicable To
- Classic TOF with all 4 components
Excludes
- Pentalogy of Fallot (Q21.82)
Clinical Validation Requirements
- Echocardiogram showing RVOT obstruction
- VSD with overriding aorta
- Right ventricular hypertrophy
Code-Specific Risks
- Confusion with similar conditions like double outlet right ventricle.
Coding Notes
- Ensure all four defects are documented for accurate coding.
Q22.0 - Pulmonary valve atresia
Use when TOF is present with pulmonary valve atresia.
Applicable To
- Pulmonary valve atresia with VSD
Excludes
- Isolated pulmonary valve atresia without VSD
Clinical Validation Requirements
- Echocardiogram confirming absence of pulmonary valve
Coding Notes
Document the presence of VSD when using this code.
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 Tetralogy of Fallot to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Q21.3.
Impact
Clinical: Incomplete patient profile., Regulatory: Non-compliance with coding standards., Financial: Potential loss of reimbursement for associated conditions.
Mitigation Strategy
Review genetic test results, Include all relevant codes
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Code Q21.3 and Q21.1 separately.
Impact
Failure to document all four defects can lead to audit flags.
Mitigation Strategy
Use structured templates to ensure comprehensive documentation.
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 Tetralogy of Fallot, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tetralogy of Fallot
Use these documentation templates to ensure complete and accurate documentation for Tetralogy of Fallot. These templates include all required elements for proper coding and billing.
Unrepaired TOF with cyanotic spells
Specialty: CardiologyRequired Elements
- Cyanotic episodes
- Echocardiogram findings
- Oxygen saturation levels
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Tetralogy of Fallot? Ask your questions below.