Q22.5 — Ebstein's anomaly
Q22.5 is a billable, specific ICD-10-CM code for ebstein's anomaly. It is valid for submission on a claim.
Risk adjustment
Q22.5 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
Q22.5 is named in 28 Medicare coverage policies — 28 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)
- A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
How Q22.5 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 Q22.5.
- Ebstein's anomaly or syndrome(heart)
- Abnormal, abnormality, abnormalities›Ebstein
- Anomaly, anomalous›Ebstein's(heart) (tricuspid valve)
- Disease, diseased›Ebstein's heart
- Syndrome›Ebstein's
- Anomaly, anomalous›tricuspid›Ebstein's
- Deformity›tricuspid›Ebstein's
Related codes at this level
Codes that share Q22. If Q22.5 is not quite right, the correct code is usually one of these.
- Q22.0Pulmonary valve atresia
- Q22.1Congenital pulmonary valve stenosis
- Q22.2Congenital pulmonary valve insufficiency
- Q22.3Other congenital malformations of pulmonary valve
- Q22.4Congenital tricuspid stenosis
- Q22.6Hypoplastic right heart syndrome
- Q22.8Other congenital malformations of tricuspid valve
- Q22.9Congenital malformation of tricuspid valve, unspecified
Questions about Q22.5
- Is Q22.5 a billable ICD-10-CM code?
- Yes. Q22.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Q22.5 sit in the tabular list?
- Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Congenital malformations of the circulatory system (Q20-Q28).