Congenital vs. Acquired


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There are a number of conditions that specify "congenital" or "acquired." How does one code when the documentation does not specify one or the other? I know that the best possible solution is to query the provider, but sometimes that is quite a challenge. For example, I code for pathology. My pathologist typically will have no further information, and I would need to contact the surgeon for the information. I have not yet come across an option for "unspecified." I cannot find any information in the coding guidelines that give direction in this situation. I would appreciate any input.
I am running into a similar situation - have you received guidance on this? I am auditing a provider's chart--patient has flat foot, but the provider is hesitant to name it congenital. I hope we can get an answer!!!
I'd also pay attention to whether the terms (congenital) or (acquired) appear in parentheses in the index. Although you may see the word "acquired" listed with a diagnosis code, if the word is in parentheses it doesn't have to be specifically stated in your documentation to assign the code.

As stated in the ICD-10-CM conventions for punctuation, words that appear in parentheses are nonessential words and do not have to be present to choose that code.

From ICD-10-CM guideline I.A.7 (Puncuation)

[ ] Brackets are used in the Tabular List to enclose synonyms, alternative wording or explanatory phrases. Brackets are used in the Alphabetic Index to identify manifestation codes.

( ) Parentheses are used in both the Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers. The nonessential modifiers in the Alphabetic Index to Diseases apply to subterms following a main term except when a nonessential modifier and a subentry are mutually exclusive, the subentry takes precedence. For example, in the ICD-10-CM Alphabetic Index under the main term Enteritis, “acute” is a nonessential modifier and “chronic” is a subentry. In this case, the nonessential modifier “acute” does not apply to the subentry “chronic”. ICD-10-CM Official Guidelines for Coding and Reporting FY 2023 Page 9 of 118

: Colons are used in the Tabular List after an incomplete term which needs one or more of the modifiers following the colon to make it assignable to a given category.