Deviated nasal septum J34.2 vs. Q67.4

bbooks

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Which code is correct when the diagnosis is "septal deviation" with no other specification? I've been going with Q67.4 but would appreciated other opinions and explanations.

J34.2 Deviated nasal septum
Deflection or deviation of septum (nasal) (acquired)
Excludes 1: congenital deviated nasal septum (Q67.4)

Q67.4 Other congenital deformities of skull, face and jaw
Congenital depressions in skull
Congenital hemifacial atrophy or hypertrophy
Deviation of nasal septum, congenital
Squashed or bent nose, congenital
Excludes 1: dentofacial anomalies [including malocclusion] (M26.-)
syphilitic saddle nose (A50.5)
 

mitchellde

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You will need documented clarification as to whether this is an acquired condition or congenital. If it is an acquired condition then is it sequela from an injury.
 

bbooks

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In pathology, we almost never have anything beyond an unspecified septal deviation, and we see so many of these with surgical specimens, it seems unrealistic that each of these should be tracked down. You raise a good point in that if it's acquired it would be secondary to an injury. So...in the absence of an etiology, would you default to Q67.4?
 
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