ICD-10 Coding for Fetal Alcohol Spectrum Disorder(Q86.0, P04.3)
Complete ICD-10-CM coding and documentation guide for Fetal Alcohol Spectrum Disorder. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fetal Alcohol Spectrum Disorder
Q86.0Primary Range
Congenital malformation syndromes due to known exogenous causes, not elsewhere classified
Primary code for Fetal Alcohol Syndrome, indicating confirmed dysmorphic features and CNS abnormalities.
Newborn affected by maternal use of alcohol
Used when there is confirmed alcohol exposure but FAS criteria are not fully met.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Q86.0 | Fetal alcohol syndrome (dysmorphic) | Use when all FAS diagnostic criteria are met, including facial dysmorphia and CNS abnormalities. |
|
| P04.3 | Newborn affected by maternal use of alcohol | Use when alcohol exposure is confirmed but FAS criteria are not fully met. |
|
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 fetal alcohol spectrum disorder
Essential facts and insights about Fetal Alcohol Spectrum Disorder
Primary ICD-10-CM Codes for fetal alcohol spectrum disorder
Decision Criteria
clinical Criteria
- Presence of characteristic facial features and CNS abnormalities.
Applicable To
- Confirmed dysmorphic facial features
- Growth deficits
- CNS abnormalities
Excludes
- Other congenital malformations
- Genetic syndromes
Clinical Validation Requirements
- Smooth philtrum
- Thin vermillion border
- Prenatal alcohol exposure
Code-Specific Risks
- Incorrect use without full diagnostic criteria
- Omission of CNS abnormalities
Coding Notes
- Ensure all diagnostic criteria are documented before using Q86.0.
P04.3 - Newborn affected by maternal use of alcohol
Use when alcohol exposure is confirmed but FAS criteria are not fully met.
Applicable To
- Suspected alcohol exposure
Excludes
- Confirmed FAS (Q86.0)
Clinical Validation Requirements
- Documented maternal alcohol use
Coding Notes
Do not use as a standalone code if FAS criteria are met.
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.
Down syndrome, unspecified
Q90.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fetal Alcohol Spectrum Disorder to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Q86.0.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure detailed maternal history is recorded., Use biomarkers if available.
Impact
Reimbursement: Potential denial due to insufficient specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of the patient's condition.
Mitigation Strategy
Ensure Q86.0 is used as the primary code when FAS criteria are satisfied.
Impact
Failure to document specific facial features can lead to audit issues.
Mitigation Strategy
Use standardized measurement tools and document all findings.
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 Fetal Alcohol Spectrum Disorder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fetal Alcohol Spectrum Disorder
Use these documentation templates to ensure complete and accurate documentation for Fetal Alcohol Spectrum Disorder. These templates include all required elements for proper coding and billing.
Newborn with suspected FASD
Specialty: PediatricsRequired Elements
- Facial phenotype documentation
- CNS assessment
- Maternal alcohol use history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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