Q21.12

Q21.12: Patent foramen ovale

Billable / specific codeICD-10-CMPOA exempt

Q21.12 is a billable, specific ICD-10-CM code for patent foramen ovale. It is valid for submission on a claim.

Check Q21.12 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Persistent foramen ovale

Excludes1 inherited from the categories above Q21.12

A category’s note binds every code beneath it.

Written on Q21: Congenital malformations of cardiac septa

acquired cardiac septal defect (I51.0)

Excludes2 inherited from the categories above Q21.12

Not part of this code, but both may be coded when both are present.

Written on Q21.1: Atrial septal defect

ostium primum atrial septal defect (type I) (Q21.20)

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

Q21.12 is named in 19 Medicare coverage policies: 19 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A52868Billing and Coding: Transesophageal Echocardiography (TEE)
A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
A56451Billing and Coding: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

Alphabetic index entries that lead here

Foramen ovale(nonclosure) (patent) (persistent)
Closure›foramen ovale, imperfect
Anomaly, anomalous›foramen›Botalli
Anomaly, anomalous›foramen›ovale
Cyanosis›due to›patent foramen botalli
Cyanosis›due to›persistent foramen ovale
Nonclosure›foramen›botalli
Nonclosure›foramen›ovale
Patent›foramen›botalli
Patent›foramen›ovale
Persistence, persistent›foramen›Botalli
Persistence, persistent›foramen›ovale

Code history

Unchanged in every release from FY2024 to FY2027.