2025 ICD-10-CM code Q74.0
Other congenital malformations of the upper limb(s), including the shoulder girdle.
Modifiers may be applicable depending on the specific procedure performed to treat the condition.
Medical necessity for treatment of conditions coded under Q74.0 would be supported by documentation indicating functional impairment, pain, or cosmetic concerns.The treatment plan should be justified by the need to improve function, alleviate pain, or address cosmetic concerns. Specific treatment recommendations should be included in the medical record.
The clinical responsibility for this code lies with physicians specializing in orthopedics, genetics, or pediatric specialties depending on the complexity and specific needs of the patient. The clinician must perform a comprehensive physical examination and order appropriate imaging (X-rays, CT scans, MRI) and/or genetic testing to determine the exact nature and extent of the upper limb malformation.
- Chapter 17 - Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- Q74.0 falls under the broader category of congenital malformations of the limbs (Q74).
In simple words: This code describes birth defects affecting one or both arms, including the shoulder area.These defects can vary widely, affecting bones, joints, and overall structure.
This code encompasses a variety of congenital malformations affecting the upper limbs, from the hand to the shoulder girdle.Specific examples include, but are not limited to, accessory carpal bones, cleidocranial dysostosis, congenital pseudarthrosis of the clavicle, macrodactyly (fingers), Madelung's deformity, radioulnar synostosis, Sprengel's deformity, and triphalangeal thumb.It excludes polydactyly, reduction defects of the limb, and syndactyly.
Example 1: A newborn presents with a noticeably shortened right arm and an underdeveloped hand.Imaging reveals a radioulnar synostosis., A child exhibits an extra bone in their left wrist, causing discomfort and limited range of motion. X-rays confirm the presence of an accessory carpal bone., A teenager presents with a high-riding scapula (Sprengel's deformity), causing cosmetic concerns and limited shoulder movement.
Comprehensive documentation should include a detailed description of the physical findings, imaging studies (if performed), genetic testing results (if applicable), and functional assessment of the affected limb(s).Prenatal history and family history of similar conditions should also be noted.
** The use of this code requires careful consideration of the specific upper limb malformation.If the condition is more precisely defined, a more specific code should be used instead of Q74.0.
- Payment Status: Active
- Specialties:Orthopedics, Genetics, Pediatrics
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center