Q38-Q45 — Other congenital malformations of the digestive system
ICD-10-CM codes Q38-Q45 cover other congenital malformations of the digestive system, within congenital malformations, deformations and chromosomal abnormalities. The block holds 70 codes across 8 categories, of which 61 are billable and 9 are header codes that cannot be submitted on a claim.
Risk adjustment in Q38-Q45
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 78 Intestinal Obstruction/Perforation
- HCC 68 Cholangitis and Obstruction of Bile Duct Without Gallstones
What else to watch in Q38-Q45
- 54 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.
Categories in Q38-Q45
- Q38Other congenital malformations of tongue, mouth and pharynx
- Q39Congenital malformations of esophagus
- Q40Other congenital malformations of upper alimentary tract
- Q41Congenital absence, atresia and stenosis of small intestine
- Q42Congenital absence, atresia and stenosis of large intestine
- Q43Other congenital malformations of intestine
- Q44Congenital malformations of gallbladder, bile ducts and liver
- Q45Other congenital malformations of digestive system