2024 ICD-10-CM Diagnosis Code Q21.0

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

• Absent left sided atrioventricular connection
• Absent pulmonary valve syndrome
• Absent pulmonary valve syndrome with ventricular septal defect of non Fallot type
• Acquired subaortic stenosis
• Acquired subaortic stenosis associated with functionally univentricular heart
• Acquired subaortic stenosis due to restrictive ventricular septal defect associated with functionally univentricular heart
• Anterior muscular trabecular ventricular septal defect
• Aortic valve overriding ventricular septum
• Aortic valve overriding ventricular septum
• Atrioventricular septal defect with additional muscular ventricular septal defect
• Central basal perimembranous ventricular septal defect
• Common atrioventricular-type ventricular septal defect
• Common atrioventricular-type ventricular septal defect
• Concordant atrioventricular connections
• Concordant atrioventricular connections
• Confluent muscular ventricular septal defect
• Congenital abnormality of truncal valve
• Congenital abnormality of truncal valve
• Congenital abnormality of truncal valve
• Congenital abnormality of ventricles and ventricular septum
• Congenital absence of pulmonary valve
• Congenital anomaly of atrioventricular septum
• Congenital atresia of pulmonary valve
• Congenital atresia of pulmonary valve
• Congenital atresia of pulmonary valve
• Congenital prolapse of aortic valve
• Congenital subaortic stenosis
• Congenital subaortic stenosis due to restrictive ventricular septal defect associated with functionally univentricular heart
• Congenital ventricular septal defect
• Discordant ventriculoarterial connection
• Discordant ventriculoarterial connection
• Double outlet right ventricle
• Double outlet right ventricle
• Double outlet right ventricle
• Double outlet right ventricle
• Double outlet right ventricle
• Double outlet right ventricle
• Double outlet right ventricle
• Double outlet right ventricle
• Double outlet right ventricle with doubly committed ventricular septal defect
• Double outlet right ventricle with doubly committed ventricular septal defect
• Double outlet right ventricle with doubly committed ventricular septal defect and pulmonary stenosis
• Double outlet right ventricle with noncommitted ventricular septal defect
• Double outlet right ventricle with subaortic or doubly committed ventricular septal defect and pulmonary stenosis Fallot type
• Double outlet right ventricle with subaortic or doubly committed ventricular septal defect without pulmonary stenosis - ventricular septal defect type
• Double outlet right ventricle with subaortic ventricular septal defect
• Double outlet right ventricle with subaortic ventricular septal defect
• Double outlet right ventricle with subaortic ventricular septal defect without pulmonary stenosis
• Double outlet right ventricle with subpulmonary ventricular septal defect
• Double outlet ventriculoarterial connections
• Doubly committed juxta-arterial outlet ventricular septal defect with anteriorly malaligned outlet septum
• Doubly committed juxta-arterial outlet ventricular septal defect with perimembranous extension
• Doubly committed juxta-arterial outlet ventricular septal defect with perimembranous extension and anteriorly malaligned outlet septum
• Doubly committed juxta-arterial outlet ventricular septal defect with perimembranous extension and posteriorly malaligned outlet septum
• Doubly committed juxta-arterial outlet ventricular septal defect with posteriorly malaligned outlet septum
• Doubly committed juxta-arterial ventricular septal defect with anteriorly malaligned fibrous outlet septum and muscular postero-inferior rim
• Doubly committed subarterial ventricular septal defect
• Doubly committed subarterial ventricular septal defect
• Doubly committed subarterial ventricular septal defect
• Doubly committed subarterial ventricular septal defect
• Doubly committed subarterial ventricular septal defect
• Doubly committed subarterial ventricular septal defect
• Doubly committed subarterial ventricular septal defect
• Doubly committed subarterial ventricular septal defect with membranous septum extension
• Doubly committed subarterial ventricular septal defect with muscular posterior inferior rim
• Doubly committed ventricular septal defect in double outlet ventriculoarterial connection
• Eisenmenger ventricular septal defect
• Endocardial cushion defect
• Functionally univentricular heart
• Functionally univentricular heart
• Giant ventricular septal defect
• Hemodynamically insignificant ventricular septal defect
• Hypoplasia of infundibular septum
• Infective endocarditis at site of patch of ventricular septal defect
• Infective endocarditis at site of ventricular septal defect
• Inferior muscular trabecular ventricular septal defect
• Laubry Pezzi syndrome
• Left ventricular-right atrial communication
• Membranous ventricular septum defect
• Membranous ventricular septum defect
• Membranous ventricular septum defect
• Membranous ventricular septum defect
• Multiple muscular ventricular septum defect
• Multiple ventricular septal defects
• Muscular ventricular septal defect in apical trabecular septum
• Muscular ventricular septal defect in central trabecular septum
• Muscular ventricular septal defect in inlet septum
• Muscular ventricular septal defect in marginal septum
• Muscular ventricular septal defect in outlet septum
• Muscular ventricular septal defect in trabecular septum
• Muscular ventricular septal defect opening to right ventricular inlet
• Muscular ventricular septum defect
• Non-restrictive ventricular septal defect
• Outlet ventricular septal defect with anteriorly malaligned outlet septum
• Outlet ventricular septal defect with posteriorly malaligned outlet septum
• Perimembranous inlet ventricular septal defect
• Perimembranous inlet ventricular septal defect
• Perimembranous inlet ventricular septal defect with atrioventricular septal malalignment
• Perimembranous outlet ventricular septal defect with anteriorly malaligned outlet septum
• Perimembranous outlet ventricular septal defect with posteriorly malaligned outlet septum
• Perimembranous ventricular septal defect
• Perimembranous ventricular septal defect
• Perimembranous ventricular septal defect
• Perimembranous ventricular septal defect
• Perimembranous ventricular septal defect with extension to all right ventricular components
• Perimembranous ventricular septal defect with extension to right ventricular inlet
• Perimembranous ventricular septal defect with extension to right ventricular outlet
• Perimembranous ventricular septal defect with extension to right ventricular trabecular component
• Pulmonary atresia and ventricular septal defect with aorta from left ventricle
• Pulmonary atresia and ventricular septal defect with aorta from right ventricle
• Pulmonary atresia with ventricular septal defect
• Residual ventricular septal defect
• Roger's disease
• Single muscular ventricular septum defect
• Spontaneous closure of ventricular septal defect
• Spontaneous closure of ventricular septal defect due to fibromuscular reaction
• Spontaneous closure of ventricular septal defect due to tissue of membranous septum
• Spontaneous reduction in size of ventricular septal defect
• Spontaneous reduction in size of ventricular septal defect
• Spontaneous reduction in size of ventricular septal defect due to accessory tissue of atrioventricular valve
• Spontaneous reduction in size of ventricular septal defect due to fibromuscular reaction
• Spontaneous reduction in size of ventricular septal defect due to prolapse of cusp of aortic valve
• Spontaneous reduction in size of ventricular septal defect due to tissue of membranous septum
• Subaortic stenosis due to restrictive ventricular septal defect in functionally univentricular heart
• Subarterial ventricular septal defect
• Supracristal ventricular septal defect
• Transposition of great arteries with concordant atrioventricular connections and ventricular septal defect
• Transposition of great arteries with concordant atrioventricular connections and ventricular septal defect and left ventricular outflow tract obstruction
• Ventricular septal abnormality
• Ventricular septal defect
• Ventricular septal defect between left ventricle and right atrium
• Ventricular septal defect of inlet of right aspect of ventricular septum
• Ventricular septal defect with absent outlet septum and overriding truncal valve
• Ventricular septal defect with absent outlet septum and overriding truncal valve with extension of membranous septum
• Ventricular septal defect with absent outlet septum and overriding truncal valve with inferior muscular rim
• Ventricular septal defect with anterior malaligned outlet septum with overriding aortic valve
• Ventricular septal defect with anterior malaligned outlet septum with overriding pulmonary valve
• Ventricular septal defect with malaligned outlet septum
• Ventricular septal defect with malaligned outlet septum to left
• Ventricular septal defect with malaligned outlet septum to right
• Ventricular septal defect with posterior malaligned outlet septum with overriding aortic valve
• Ventricular septal defect with posterior malaligned outlet septum with overriding pulmonary valve

Clinical Information

• Double Outlet Right Ventricle

  incomplete transposition of the great vessels in which both the aorta and the pulmonary artery arise from the right ventricle. the only outlet of the left ventricle is a large ventricular septal defect (ventricular septal defects or vsd). the various subtypes are classified by the location of the septal defect, such as subaortic, subpulmonary, or noncommitted.

• Discordant Ventriculoarterial Connection

  a rare congenital cardiovascular abnormality in which the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle.

Q21.0 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
306	CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC	05	1.5368
307	CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC	05	0.9426

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Present on Admission (POA)

Q21.0 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.

CMS POA Indicator Options and Definitions

POA Indicator	Reason for Code	CMS will pay the CC/MCC DRG?
Y	Diagnosis was present at time of inpatient admission.	YES
N	Diagnosis was not present at time of inpatient admission.	NO
U	Documentation insufficient to determine if the condition was present at the time of inpatient admission.	NO
W	Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.	YES
1	Unreported/Not used - Exempt from POA reporting.	NO

Convert Q21.0 to ICD-9-CM

• ICD-9-CM Code: 745.4 - Ventricular sept defect
  Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Patient Education

Congenital Heart Defects

What are congenital heart defects?

Congenital heart defects (CHDs) are problems with the structure of the heart. "Congenital" means that that the problems are present at birth. These defects happen when a baby's heart doesn't develop normally during pregnancy. Congenital heart defects are the most common type of birth defect.

Congenital heart defects can change the way the heart pumps blood. They may make blood flow too slowly, go the wrong way, or block it completely.

There are many types of congenital heart defects. They can happen in one or more parts of the heart. The most common types are:

• Septal defects ("hole in the heart") - openings in the wall between the left and right sides of the heart
• Heart valve defects - problems with the valves that control the flow of blood through the heart
• Defects in the large blood vessels that carry blood in and out of the heart

Congenital heart defects can range from very mild problems that never need treatment to life-threatening problems at birth. The most serious congenital heart defects are called critical congenital heart disease. Babies with these defects usually need surgery in the first year of life. But the symptoms of milder heart defects may not show up until childhood or adulthood.

What causes congenital heart defects?

Researchers often don't know what causes congenital heart defects. They do know that changes in a baby's genes sometimes cause a heart defect. The changed genes may come from the parents, or the changes may happen during pregnancy.

Who is more likely to have a baby with a congenital heart defect?

Several things may increase the chance that your baby has a congenital heart defect, such as:

• Your health before and during pregnancy, including
  • Having diabetes before pregnancy or developing it in the first 3 months of pregnancy (diabetes that develops later in pregnancy isn't a major risk for heart defects). Carefully controlling your blood sugar before and during pregnancy can lower your baby's risk of congenital heart defects.
  • Having phenylketonuria (PKU), a rare inherited disorder that affects how the body uses a protein in foods. If you have PKU, eating a low-protein diet before getting pregnant can lower your baby's risk of having a congenital heart defect.
  • Having rubella (German measles) during pregnancy.
• Your contact with certain substances during pregnancy, including
  • Smoking or secondhand smoke (breathing smoke from another smoker).
  • Certain medicines, such as angiotensin-converting (ACE) inhibitors for high blood pressure and retinoic acids for acne. If you're pregnant or plan to get pregnant, talk with your health care provider about all the medicines you take.
• Your family history and genetics. In most cases, congenital heart defects don't run in families. But your chance of having a baby with a congenital heart defect does go up if you or the other parent has a congenital heart defect, or if you already have a child with a congenital heart defect.

What are the symptoms of congenital heart defects?

Congenital heart defects don't cause pain. The signs and symptoms are different, depending on the type and number of defects and how serious they are.

Common signs and symptoms of congenital heart defects include:

• Cyanosis - a bluish color to the skin, lips, and fingernails. It happens when there isn't enough oxygen in the blood
• Fatigue - your baby may be unusually sleepy and may become very tired during feedings
• Poor blood flow
• Fast or difficult breathing
• Heart murmur - an unusual sound between heartbeats

What other problems do congenital heart defects cause?

Congenital heart defects don't always cause other problems. If they do, which problems you have would depend on the type and number of defects and how serious the defects are.

Children with congenital heart defects are more likely to:

• Be smaller than other children
• Have problems or delays in mental, and emotional growth, and behavior, such as:
  • Speech and language problems
  • Attention deficit hyperactivity disorders (ADHD)

People with congenital heart defects may develop other health conditions, including:

• Endocarditis - an infection of lining of the heart and valves
• Arrhythmia - a problem with the rate or rhythm of your heartbeat
• Heart failure - when your heart can't pump enough blood to the body
• Pulmonary hypertension - high blood pressure in your lungs
• Kidney and liver disease

How are congenital heart defects diagnosed?

• Before a baby is born, your provider may use ultrasound pictures of the baby's heart to look for heart defects. This is called a fetal echocardiogram. It's done between weeks 18 and 22 of pregnancy.
• During the first few days after birth, all newborns are checked for congenital heart defects. A pulse oximeter is clipped to your baby's hands or feet to measure blood oxygen. If it shows low levels of blood oxygen, more tests will be needed to find out if your baby has a heart defect.
• To diagnose congenital heart defects in babies, children, and adults, a provider may use many tools, including:
  • A physical exam.
  • Certain heart tests to see how the heart is working.
  • Genetic testing to see if certain gene problems caused the defect.

What are the treatments for congenital heart defects?

Treatment depends on the type of congenital heart defect and how serious it is. Possible treatments include:

• Cardiac catheterization to repair simple defects, such as a small hole in the inside wall of the heart. A catheterization uses a thin tube guided through a vein and into the heart.
• Heart surgery may be needed to:
  • Repair defects in the heart and blood vessels.
  • Repair or replace a heart valve.
  • Place a device in the chest to help the heart pump blood.
  • Do a heart transplant.
• Medicine is often used if your baby has a specific type of congenital heart defect called patent ductus arteriosus.

All children and adults who have congenital heart defects need regular follow-up care from a cardiologist (a doctor who specializes in heart diseases) throughout their life, even if their defect was repaired.

Some people may need several heart surgeries or catheterizations over the years. They may also need to take medicines to help their hearts work as well as possible.

NIH: National Heart, Lung, and Blood Institute

[Learn More in MedlinePlus]

Code History

• FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.