Is ICD-10-CM code Q40 billable?

No, Q40 (Other congenital malformations of upper alimentary tract) 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 Q40 belong to?

Q40 belongs to Chapter 17 of the ICD-10-CM tabular list: Q00–Q99 (Congenital Malformations, Deformations and Chromosomal Abnormalities).

Q40Not billable, use a more specific code below

Other congenital malformations of upper alimentary tract

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

6 billable codes under Q40: none are a CC or MCC; 1 map to HCC 78 (Intestinal Obstruction/Perforation).An HCC counts toward a Medicare Advantage patient's risk score.

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 Q40

Q40 can't be used on a claim. Pick a billable code below; grey headings group them.

Q40 MS-DRGs

As the principal diagnosis, all 6 billable codes under Q40 group to MS-DRG 393, 394, or 395 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

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.

Digestive Diseases

When you eat, your body breaks food down to a form it can use to build and nourish cells and provide energy. This process is called digestion. Your digestive system is a series of hollow organs joined in a long, twisting tube. It runs from your mouth to your anus and includes your esophagus, stomach, and small and large intestines. Your liver, gallbladder and pancreas are also involved. They produce juices to help digestion.

Code history

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