Is Q04.3 a billable ICD-10-CM code?

Yes. Q04.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Q04.3 sit in the tabular list?

Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Congenital malformations of the nervous system (Q00-Q07).

What cannot be coded together with Q04.3?

Q04.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

Q04.3

Q04.3 — Other reduction deformities of brain

Billable / specific codeICD-10-CMPOA exempt

Q04.3 is a billable, specific ICD-10-CM code for other reduction deformities of brain. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

congenital malformations of corpus callosum (Q04.0)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Absence of part of brain
Agenesis of part of brain
Agyria
Aplasia of part of brain
Hydranencephaly
Hypoplasia of part of brain
Lissencephaly
Microgyria
Pachygyria

Risk adjustment

Q04.3 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 182 Spinal Cord Disorders/Injuries0.478 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

Q04.3 is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
A56612Billing and Coding: CT of the Head
A57204Billing and Coding: MRI and CT Scans of the Head and Neck

How Q04.3 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to Q04.3.

Agyria
Hydrancephaly, hydranencephaly
Lissencephalia, lissencephaly
Microgyria(congenital)
Pachygyria
Absence›cerebellum(vermis)
Agenesis›cerebellum
Agenesis›vermis of cerebellum
Aplasia›cerebellum
Hypoplasia, hypoplastic›cerebellum
Absence›brain›part of
Agenesis›brain›part of

Related codes at this level

Codes that share Q04. If Q04.3 is not quite right, the correct code is usually one of these.

Questions about Q04.3

Is Q04.3 a billable ICD-10-CM code?: Yes. Q04.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Q04.3 sit in the tabular list?: Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Congenital malformations of the nervous system (Q00-Q07).
What cannot be coded together with Q04.3?: Q04.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.