Q21.12 Patent foramen ovale

The ICD-10-CM code for Patent foramen ovale is Q21.12 (FY2026). It is a billable, claim-ready diagnosis code.

Classification

Chapter

17: Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0)

Section

Q20-Q28: Congenital malformations of the circulatory system (Q20-Q28)

Category Q21

20 codes (17 billable)

FY2026 Status

Stable since FY2024

Also Known As

ICD-10-CM Alphabetic Index entries that lead to Q21.12:

• Foramen ovale (nonclosure) (patent) (persistent)
• Closure › foramen ovale, imperfect
• Cyanosis › due to › patent foramen botalli
• Nonclosure › foramen › botalli
• Anomaly, anomalous (congenital) (unspecified type) › foramen › ovale
• Cyanosis › due to › persistent foramen ovale
• Anomaly, anomalous (congenital) (unspecified type) › foramen › Botalli
• Nonclosure › foramen › ovale

Inclusion Terms

• Persistent foramen ovale

U.S. Hospital Utilization

• An estimated 210,690 U.S. inpatient stays in 2023 included Q21.12 among the documented diagnoses.
• 1,540 stays listed it as the principal diagnosis.

Source: National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, 2016–2023. National survey-weighted estimates.

Official Coding Guidelines

POA indicator for congenital conditions/anomalies and Q00-Q99 exception

Congenital conditions and anomalies Assign “Y” for congenital conditions and anomalies except for categories Q00- Q99, Congenital anomalies, which are on the exempt list. Congenital conditions are always considered present on admission.

Source: CMS — ICD-10-CM Official Guidelines for Coding and Reporting, FY2026

References

• CMS — ICD-10-CM Official Code Set and Guidelines, FY2026
• CDC/NCHS — ICD-10-CM Files and Browser Tool
• AHRQ — HCUP National Inpatient Sample, Frequencies by Diagnosis Code (2016–2023)