2025 ICD-10-CM code Q21.1
(Active) Effective Date: N/A Revision Date: N/A Congenital malformations - Congenital malformations of the circulatory system Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) Feed
Atrial septal defect; a congenital hole in the wall between the heart's upper chambers (atria).
Modifiers may be applicable depending on the circumstances of the procedure. Consult official modifier guidelines for specific scenarios.
Medical necessity for the diagnosis and management of atrial septal defect is established based on the presence of symptoms (such as shortness of breath, fatigue, cyanosis) or the potential for future complications (e.g., heart failure, pulmonary hypertension, stroke) related to the size and location of the defect.Interventional or surgical intervention may be medically necessary based on severity and patient's clinical status.
Diagnosis and management of atrial septal defect requires a multidisciplinary approach involving cardiologists, pediatric cardiologists (if applicable), and cardiac surgeons. The clinical responsibility includes performing a thorough physical examination, echocardiography, cardiac catheterization (if needed), and managing any associated symptoms. In some cases, surgical or interventional closure of the defect may be required.
- Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- Q21 Congenital malformations of cardiac septa
In simple words: This code describes a hole in the wall between the two upper chambers of the heart.This hole is present from birth and may cause extra strain on the heart and lungs.The size and location of the hole determine the severity of the condition.
Q21.1, Atrial septal defect, is an ICD-10-CM code representing a congenital condition characterized by an abnormal opening in the interatrial septum, the wall separating the heart's two upper chambers (left and right atria). This defect allows abnormal blood flow between the atria, potentially leading to increased strain on the heart and lungs.The condition is present at birth and may manifest with varying symptoms depending on the size and location of the septal defect.It is crucial to differentiate Q21.1 from other cardiac septal defects, such as ventricular septal defects (Q21.0) or atrioventricular septal defects (Q21.2).
Example 1: A newborn infant presents with a heart murmur.Echocardiography confirms the presence of an atrial septal defect. The infant is monitored for symptoms and scheduled for a follow-up echocardiogram., A 10-year-old child experiences shortness of breath and fatigue during physical activity.A diagnostic workup reveals an atrial septal defect that requires surgical intervention to correct the septal defect., An adult patient is diagnosed with an atrial septal defect during a routine checkup. They are asymptomatic, but the defect is monitored via regular echocardiograms and are advised to avoid strenuous activities.
Complete medical history, physical examination findings, echocardiogram report, cardiac catheterization report (if applicable), and any other relevant diagnostic tests.Surgical or interventional procedure reports if applicable.
** This code should only be used for congenital atrial septal defects. Acquired defects are coded elsewhere.Always confirm the diagnosis with appropriate imaging studies before coding.
- Payment Status: Active
- Modifier TC rule: Not applicable to this diagnosis code.Modifiers apply to procedural codes.
- Specialties:Cardiology, Pediatric Cardiology, Cardiac Surgery
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center