Is ICD-10-CM code Q38 billable?

No, Q38 (Other congenital malformations of tongue, mouth and pharynx) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code Q38 belong to?

Q38 belongs to Chapter 17 of the ICD-10-CM tabular list: Q00–Q99 (Congenital Malformations, Deformations and Chromosomal Abnormalities).

Q38Not billable, use a more specific code below

Other congenital malformations of tongue, mouth and pharynx

In Other congenital malformations of the digestive system (Q38-Q45), chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities

9 billable codes under Q38: none are a CC or MCC; none map to an HCC.

Instructional notes

Excludes1: not coded here, use a different code

dentofacial anomalies (M26.-)
macrostomia (Q18.4)
microstomia (Q18.5)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Assign Q00-QA1 codes for documented congenital anomalies or genetic disorders at any age, coding non-inherent manifestations separately and sequencing Z38 first on the birth admission.

Read Section I.C.17 (page 74)

All codes under Q38

Q38 can't be used on a claim. Pick a billable code below; grey headings group them.

Q38 MS-DRGs

As the principal diagnosis, the billable codes under Q38 group to these 9 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 154 Other Ear, Nose, Mouth and Throat Diagnoses with MCC (1 of 9 codes)
DRG 155 Other Ear, Nose, Mouth and Throat Diagnoses with CC (1 of 9 codes)
DRG 156 Other Ear, Nose, Mouth and Throat Diagnoses without CC/MCC (1 of 9 codes)
DRG 157 Dental and Oral Diseases with MCC (1 of 9 codes)
DRG 158 Dental and Oral Diseases with CC (1 of 9 codes)
DRG 159 Dental and Oral Diseases without CC/MCC (1 of 9 codes)
DRG 393 Other Digestive System Diagnoses with MCC (1 of 9 codes)
DRG 394 Other Digestive System Diagnoses with CC (1 of 9 codes)
DRG 395 Other Digestive System Diagnoses without CC/MCC (1 of 9 codes)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Birth Defects

A birth defect is a problem that happens while a baby is developing in the mother's body. Most birth defects happen during the first 3 months of pregnancy. One out of every 33 babies in the United States is born with a birth defect.

Mouth Disorders

Your mouth is one of the most important parts of your body. It has many different functions. It allows you to: Any problem that affects your mouth can make it hard to eat, drink, or even smile. Some common mouth problems include:

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.