2025 ICD-10-CM code Q87.11
(Active) Effective Date: N/A Congenital malformations, deformations and chromosomal abnormalities - Other congenital malformations 17 Feed
Prader-Willi syndrome.
Medical necessity for services related to PWS stems from the chronic and complex nature of the disorder. Management requires multidisciplinary care involving endocrinologists, geneticists, dieticians, therapists, and other specialists to address the various physical, developmental, and behavioral challenges. Justification for services should clearly link the need for intervention to the specific manifestations of PWS in the individual patient.
In simple words: Prader-Willi syndrome is a genetic condition present from birth. Babies with PWS are floppy and have trouble feeding. Later, they develop an insatiable appetite and become obese if their food intake is not controlled. They also have learning disabilities, tend to be short, and can have behavioral challenges.
Prader-Willi syndrome (PWS) is a complex genetic disorder affecting chromosome 15. It is characterized by hypotonia (low muscle tone) in infancy, followed by hyperphagia (excessive hunger) leading to obesity. Other features include intellectual disability, short stature, and behavioral problems.
Example 1: A newborn presents with hypotonia, weak cry, and difficulty feeding. Genetic testing confirms a diagnosis of Prader-Willi syndrome., A 5-year-old child exhibits increasing appetite, weight gain, and obsessive food-seeking behaviors. After evaluation, they receive a diagnosis of Prader-Willi Syndrome., A young adult with Prader-Willi syndrome experiences behavioral challenges, including temper outbursts and obsessive-compulsive tendencies, related to their condition.
Diagnosis of PWS requires genetic testing. Documentation should include clinical features like hypotonia in infancy, history of feeding difficulties, developmental delays, onset of hyperphagia, and behavioral issues. Genetic test results confirming the diagnosis are crucial.
** Excludes1: Ellis-van Creveld syndrome (Q77.6) and Smith-Lemli-Opitz syndrome (E78.72). Excludes2: inborn errors of metabolism (E70-E88). Code is exempt from the POA (Present on Admission) reporting requirement.
- Specialties:Genetics, Endocrinology, Pediatrics, Psychiatry, Developmental-Behavioral Pediatrics, Nutrition/Dietetics