ICD-10 Coding for Stretched Foramen Ovale(Q21.12, Q21.11)
Complete ICD-10-CM coding and documentation guide for Stretched Foramen Ovale. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Stretched Foramen Ovale
Q21.1-Q21.3Primary Range
Congenital malformations of cardiac septa
Includes codes for atrial septal defects and patent foramen ovale, relevant for coding stretched PFO.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Q21.12 | Patent foramen ovale | Use when a PFO is present with a right-to-left shunt confirmed by echocardiography. |
|
| Q21.11 | Secundum atrial septal defect | Use when a stretched PFO meets the criteria for an ASD. |
|
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 stretched foramen ovale
Essential facts and insights about Stretched Foramen Ovale
Primary ICD-10-CM Codes for stretched foramen ovale
Decision Criteria
clinical Criteria
- Presence of right-to-left shunt on echocardiography
Applicable To
- Uncomplicated PFO without hemodynamic significance
Excludes
- Atrial septal defect (Q21.1)
Clinical Validation Requirements
- Right-to-left shunt >20 microbubbles within 3 cardiac cycles
- TEE showing PFO tunnel length ≥8 mm
Code-Specific Risks
- Misclassification as ASD if criteria are not met.
Coding Notes
- Ensure echocardiographic findings are documented to support the presence of a shunt.
Q21.11 - Secundum atrial septal defect
Use when a stretched PFO meets the criteria for an ASD.
Applicable To
- Stretched PFO meeting ASD criteria
Excludes
- Patent foramen ovale (Q21.12)
Clinical Validation Requirements
- Septal excursion >10 mm
- Shunt >30 microbubbles
Coding Notes
Document echocardiographic criteria clearly to justify ASD coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for cardiovascular screening
Z00.6Differential 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 Stretched Foramen Ovale to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Q21.12.
Impact
Clinical: Inaccurate assessment of hemodynamic significance., Regulatory: Potential audit issues due to insufficient documentation., Financial: Loss of reimbursement for procedures if medical necessity is not documented.
Mitigation Strategy
Ensure bubble study results are included in the report., Train staff on documentation requirements.
Impact
Reimbursement: Potential for incorrect DRG assignment affecting reimbursement., Compliance: Risk of audit failure due to incorrect coding., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Ensure echocardiographic findings support the criteria for ASD.
Impact
Inadequate documentation of echocardiographic findings can lead to audit issues.
Mitigation Strategy
Ensure all echocardiographic findings are thoroughly documented and reviewed.
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 Stretched Foramen Ovale, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Stretched Foramen Ovale
Use these documentation templates to ensure complete and accurate documentation for Stretched Foramen Ovale. These templates include all required elements for proper coding and billing.
Cryptogenic Stroke with PFO
Specialty: CardiologyRequired Elements
- Echocardiographic findings
- Clinical correlation
- Exclusion of other embolic sources
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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