2025 ICD-10-CM code Q38.0
Congenital malformations of lips, not elsewhere classified.
Medical necessity for intervention related to congenital lip malformations must be established based on the specific condition. This could be related to functional impairment, such as difficulty feeding, speech problems, or potential airway compromise. It could also be related to psychosocial concerns related to the appearance of the lip malformation.Documentation should clearly support the medical necessity of any procedures or therapies.
Diagnosis and management of patients with congenital lip malformations falls under the purview of various specialists, depending on the specific condition and the patient's age. These may include pediatricians, plastic surgeons, oral and maxillofacial surgeons, geneticists, speech-language pathologists, and others.The clinical responsibility includes a thorough assessment, diagnosis, and development of a treatment plan, which might involve surgical intervention, therapy, or ongoing monitoring, depending on the severity and type of malformation.
In simple words: This code indicates a birth defect affecting the lips that isn't covered by other, more specific codes.Examples include a fistula (abnormal connection) in the lip, general lip malformations, or Van der Woude syndrome (a genetic condition that can cause pits in the lower lip and cleft lip/palate).This code doesn't include cleft lip, cleft lip with cleft palate, unusually large lips (macrocheilia), or unusually small lips (microcheilia), as those have their own codes.
This code represents a congenital malformation affecting the lips that is not classified elsewhere in the ICD-10-CM. This includes conditions like congenital fistula of the lip, congenital malformation of the lip NOS, and Van der Woude's syndrome. Conditions such as cleft lip (Q36.-), cleft lip with cleft palate (Q37.-), macrocheilia (Q18.6), and microcheilia (Q18.7) are excluded from this code.
Example 1: A newborn infant is noted to have a small fistula on their upper lip, which is diagnosed as a congenital fistula of the lip. This is coded as Q38.0., A child presents with an unusual lip shape, not fitting the criteria for cleft lip or other specific lip malformations. After a thorough evaluation, the condition is diagnosed as a congenital malformation of the lip NOS, coded as Q38.0., Genetic testing reveals that a patient with pits on their lower lip has Van der Woude syndrome, which can include lip malformations. The lip anomaly is coded as Q38.0.
Thorough clinical documentation of the lip malformation is essential for proper coding. This documentation should include a detailed description of the anomaly's location, size, and characteristics. Any associated conditions or syndromes, such as Van der Woude's syndrome, should be documented.If surgical repair is planned or performed, operative reports should also be included.
** It is important to note that Q38.0 is exempt from the Present on Admission (POA) reporting requirement.
- Specialties:Pediatrics, Plastic Surgery, Oral and Maxillofacial Surgery, Genetics, Speech-Language Pathology
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Office, Ambulatory Surgical Center