ICD-10 Coding for Fetal Alcohol Syndrome(Q86.0, P04.3)
Complete ICD-10-CM coding and documentation guide for Fetal Alcohol Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fetal Alcohol Syndrome
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 for confirmed FAS cases in any age group. |
|
| P04.3 | Newborn affected by maternal alcohol use | Use for newborns with suspected exposure but no confirmed FAS features. |
|
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 syndrome
Essential facts and insights about Fetal Alcohol Syndrome
Primary ICD-10-CM Codes for fetal alcohol syndrome
Decision Criteria
clinical Criteria
- Presence of all diagnostic criteria for FAS.
coding Criteria
- Do not use with P04.3.
Applicable To
- Confirmed FAS diagnosis
Excludes
- P04.3 - Newborn affected by maternal alcohol use
Clinical Validation Requirements
- All 3 facial features
- Growth deficiency
- CNS abnormalities
- Confirmed prenatal alcohol exposure
Code-Specific Risks
- Mixing with P04.3
- Vague CNS documentation
Coding Notes
- Ensure all diagnostic criteria are documented before using Q86.0.
P04.3 - Newborn affected by maternal alcohol use
Use for newborns with suspected exposure but no confirmed FAS features.
Applicable To
- Suspected maternal alcohol exposure
Excludes
- Q86.0 - Fetal alcohol syndrome (dysmorphic)
Clinical Validation Requirements
- Maternal alcohol use during pregnancy
- No confirmed FAS features
Coding Notes
Ensure documentation of maternal alcohol use is present.
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 Fetal Alcohol Syndrome 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 or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Use specific neuropsychological test scores., Document deficits in specific domains.
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Non-compliance with ICD-10 coding rules., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Delete P04.3; FAS supersedes suspected exposure codes.
Impact
Incorrect use of Q86.0 with P04.3.
Mitigation Strategy
Educate coders on Excludes1 notes and proper code usage.
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 Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fetal Alcohol Syndrome
Use these documentation templates to ensure complete and accurate documentation for Fetal Alcohol Syndrome. These templates include all required elements for proper coding and billing.
Pediatric Progress Note
Specialty: PediatricsRequired Elements
- Facial features
- Growth measurements
- Neurodevelopmental findings
- Alcohol exposure history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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