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Q21.20

Billable

Atrioventricular septal defect, unspecified as to partial or complete

HCC Category Mapping

RxHCCHCC 191Congenital Heart/Circulatory Disorders and Fontan Circulation
0.000

What This Code Means

A birth defect where there is an abnormal opening in the wall between the upper and lower heart chambers, but it is not specified whether the defect is partial or complete.

Coding Tips

  • This is an unspecified code; query the provider for clarification on whether the defect is partial or complete to allow for more specific coding
  • Review echocardiogram reports or surgical findings to determine the extent of the defect

Clinical Significance

Atrioventricular septal defect represents a complex heart malformation involving abnormal development of the central heart structures, potentially affecting all four chambers. This condition requires careful assessment to determine the extent of involvement and appropriate surgical planning.

Documentation Requirements

  • Echocardiographic assessment of septal defect extent
  • Evaluation of atrioventricular valve involvement
  • Assessment of both atrial and ventricular components
  • Hemodynamic significance and shunt assessment
  • Associated cardiac anomalies
  • Need for surgical intervention
  • Current cardiac function and symptoms
  • Growth and development monitoring

Commonly Confused Codes

Code Hierarchy

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