Q21.12 — Patent foramen ovale
Q21.12 is a billable, specific ICD-10-CM code for patent foramen ovale. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Persistent foramen ovale
Risk adjustment
Q21.12 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
Q21.12 is named in 31 Medicare coverage policies — 31 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A52868Billing and Coding: Transesophageal Echocardiography (TEE)
- A52868Billing and Coding: Transesophageal Echocardiography (TEE)
How Q21.12 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to Q21.12.
- 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
Related codes at this level
Codes that share Q21.1. If Q21.12 is not quite right, the correct code is usually one of these.
- Q21.10Atrial septal defect, unspecified
- Q21.11Secundum atrial septal defect
- Q21.13Coronary sinus atrial septal defect
- Q21.14Superior sinus venosus atrial septal defect
- Q21.15Inferior sinus venosus atrial septal defect
- Q21.16Sinus venosus atrial septal defect, unspecified
- Q21.19Other specified atrial septal defect
Questions about Q21.12
- Is Q21.12 a billable ICD-10-CM code?
- Yes. Q21.12 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Q21.12 sit in the tabular list?
- Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Congenital malformations of the circulatory system (Q20-Q28).