Congenital absence, atresia and stenosis of large intestine
In Other congenital malformations of the digestive system (Q38-Q45), chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities
6 billable codes under Q42: all are a CC; all map to HCC 78 (Intestinal Obstruction/Perforation).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.
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Instructional notes
Includes: conditions that are coded here
- congenital obstruction, occlusion and stricture of large intestine
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.
All codes under Q42
Q42 can't be used on a claim. Pick a billable code below; grey headings group them.
- Q42.0Congenital absence, atresia and stenosis of rectum with fistula
- Q42.1Congenital absence, atresia and stenosis of rectum without fistula
- Q42.2Congenital absence, atresia and stenosis of anus with fistula
- Q42.3Congenital absence, atresia and stenosis of anus without fistula
- Q42.8Congenital absence, atresia and stenosis of other parts of large intestine
- Q42.9Congenital absence, atresia and stenosis of large intestine, part unspecified
Q42 MS-DRGs
As the principal diagnosis, all 6 billable codes under Q42 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.
Other codes that refer to Q42
Notes on these codes point to Q42.
- K56 Excludes1: congenital stricture or stenosis of intestine (Q41-Q42)
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.
Read more about birth defects on MedlinePlusColonic Diseases
Your colon, also known as the large intestine, is part of your digestive system. It's a long, hollow tube at the end of your digestive tract where your body makes and stores stool. Many disorders affect the colon's ability to work properly. Some of these include:
Read more about colonic diseases on MedlinePlusCode history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.