Q12.4 ICD-10-CM Code: Spherophakia

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for Q12.4 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on Q12.4 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for Q12.4

MedCoder structured workflow — derived from this code’s own official record

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

• Excludes2 — not part of Q12.4(7 notes)

  Coding workflow: The conditions named in this note are not included in Q12.4. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareQ05.0, Q05.5, Q67.5, Q31, Q38.0, Q30

  See the official tabular notes · Guidelines I.A.12.b

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Increase, increased, sphericity, lens
• Sphericity, increased, lens (congenital)
• Spherophakia

Don’t confuse Q12.4 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of Q12.4 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• Q12.9— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Congenital lens malformation, unspecified” takes Q12.9; specificity in the record moves it back here.

  Full comparison: Q12.4 vs Q12.9 →

• Q35— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of cleft lip and cleft palate adds Q35; it is not part of this code and both may be reported when both are documented.

  Full comparison: Q12.4 vs Q35 →

• Q37— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of cleft lip and cleft palate adds Q37; it is not part of this code and both may be reported when both are documented.

  Full comparison: Q12.4 vs Q37 →

• Q05.0— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of congenital malformation of cervical spine adds Q05.0; it is not part of this code and both may be reported when both are documented.

  Full comparison: Q12.4 vs Q05.0 →

• Q05.5— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of congenital malformation of cervical spine adds Q05.5; it is not part of this code and both may be reported when both are documented.

  Full comparison: Q12.4 vs Q05.5 →

• Q67.5— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of congenital malformation of cervical spine adds Q67.5; it is not part of this code and both may be reported when both are documented.

  Full comparison: Q12.4 vs Q67.5 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name Q12.4 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: H27 — Other disorders of lens (via Q12.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 124 (MDC 02), DRG 125 (MDC 02).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MAL005 — Congenital malformations of eye, ear, face, neck (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Congenital malformations of eye, ear, face, neck).

Q10.6 — Other congenital malformations of lacrimal apparatus, Q10.7 — Congenital malformation of orbit, Q11.0 — Cystic eyeball, Q11.1 — Other anophthalmos, Q11.2 — Microphthalmos, Q11.3 — Macrophthalmos, Q12.0 — Congenital cataract, Q12.1 — Congenital displaced lens, Q12.2 — Coloboma of lens, Q12.3 — Congenital aphakia, Q12.8 — Other congenital lens malformations, Q12.9 — Congenital lens malformation, unspecified, Q13.0 — Coloboma of iris, Q13.1 — Absence of iris, Q13.2 — Other congenital malformations of iris, Q13.3 — Congenital corneal opacity, Q13.4 — Other congenital corneal malformations, Q13.5 — Blue sclera, Q13.81 — Rieger anomaly, Q13.89 — Other congenital malformations of anterior segment of eye, +41 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Increase, increased”; these codes share that main term but sit in a different category of the Tabular List.

D73.1 — Hypersplenism (splenic activity), E16.3 — Increased secretion of glucagon (secretion, glucagon), E16.4 — Increased secretion of gastrin (secretion, gastrin), E16.8 — Other specified disorders of pancreatic internal secretion (secretion, pancreas, endocrine, somatostatin), E16.9 — Disorder of pancreatic internal secretion, unspecified (secretion, pancreas, endocrine), E22.2 — Syndrome of inappropriate secretion of antidiuretic hormone (function, pituitary, posterior), E22.9 — Hyperfunction of pituitary gland, unspecified (function, pituitary), E27.5 — Adrenomedullary hyperfunction (function, adrenal, medulla), E28.0 — Estrogen excess (estrogen), E28.1 — Androgen excess (androgens), G93.2 — Benign intracranial hypertension (intracranial pressure), I78.8 — Other diseases of capillaries (permeability, capillaries), I87.8 — Other specified disorders of veins (venous pressure), K76.6 — Portal hypertension (venous pressure, portal), R20.8 — Other disturbances of skin sensation (heat sense), R63.8 — Other symptoms and signs concerning food and fluid intake (abnormal, in development)

Contextual Map

Every relationship of Q12.4 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run Q12.4 with this related code in Claim Check

Hierarchy

• Q00-QA1 — Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-QA1) (Q00-QA1)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• Q10-Q18 — Congenital malformations of eye, ear, face and neck[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• H27 — Other disorders of lens[Excludes1](via Q12.-): “congenital lens malformations (Q12.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• MAL005 — Congenital malformations of eye, ear, face, neck[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT[MS-DRG]: “OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC[MS-DRG]: “OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 02 — Diseases and Disorders of the Eye[MDC crossing]: “Diseases and Disorders of the Eye — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,200 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Increase, increased, sphericity, lens[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Sphericity, increased, lens (congenital)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Spherophakia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

• Q12 — Congenital lens malformations[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• Q12.0 — Congenital cataract[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• Q12.1 — Congenital displaced lens[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• Q12.2 — Coloboma of lens[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• Q12.3 — Congenital aphakia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• Q12.8 — Other congenital lens malformations[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• Q12.9 — Congenital lens malformation, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to Q12.4 in its code family, with their registry titles.

• Q12 — Congenital lens malformations
• Q12.0 — Congenital cataract
• Q12.1 — Congenital displaced lens
• Q12.2 — Coloboma of lens
• Q12.3 — Congenital aphakia
• Q12.8 — Other congenital lens malformations
• Q12.9 — Congenital lens malformation, unspecified

View all codes in the Q12 family