Is Q38.0 a billable ICD-10-CM code?

Yes. Q38.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Q38.0 sit in the tabular list?

Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Other congenital malformations of the digestive system (Q38-Q45).

What cannot be coded together with Q38.0?

Q38.0 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

Q38.0

Q38.0 — Congenital malformations of lips, not elsewhere classified

Billable / specific codeICD-10-CMPOA exempt

Q38.0 is a billable, specific ICD-10-CM code for congenital malformations of lips, not elsewhere classified. 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.

cleft lip (Q36.-)
cleft lip with cleft palate (Q37.-)
macrocheilia (Q18.6)
microcheilia (Q18.7)

Inclusion terms

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

Congenital fistula of lip
Congenital malformation of lip NOS
Van der Woude's syndrome

Other codes that can never be billed with Q38.0

These codes carry an Excludes1 note pointing at Q38.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading Q38.0 alone.

K13.0Diseases of lips

Risk adjustment

Q38.0 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

How Q38.0 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 Q38.0.

Van der Woude's syndrome
Agenesis›lip
Anomaly, anomalous›lip
Malformation›lip
Deformity›lip NEC›congenital
Ectropion›lip›congenital
Fistula›lip›congenital

Related codes at this level

Codes that share Q38. If Q38.0 is not quite right, the correct code is usually one of these.

Questions about Q38.0

Is Q38.0 a billable ICD-10-CM code?: Yes. Q38.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Q38.0 sit in the tabular list?: Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Other congenital malformations of the digestive system (Q38-Q45).
What cannot be coded together with Q38.0?: Q38.0 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.