Q40.1 — Congenital hiatus hernia
Q40.1 is a billable, specific ICD-10-CM code for congenital hiatus hernia. 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 diaphragmatic hernia (Q79.0)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Congenital displacement of cardia through esophageal hiatus
Other codes that can never be billed with Q40.1
These codes carry an Excludes1 note pointing at Q40.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading Q40.1 alone.
Risk adjustment
Q40.1 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.
Medicare coverage
Q40.1 is named in 5 Medicare coverage policies — 5 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56389Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
- A56781Billing and Coding: Transthoracic Echocardiography (TTE)
- A56781Billing and Coding: Transthoracic Echocardiography (TTE)
- A57063Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
How Q40.1 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 Q40.1.
- Displacement, displaced›cardia through esophageal hiatus(congenital)
- Hernia, hernial›hiatal›congenital
- Hernia, hernial›paraesophageal›congenital
Related codes at this level
Codes that share Q40. If Q40.1 is not quite right, the correct code is usually one of these.
Questions about Q40.1
- Is Q40.1 a billable ICD-10-CM code?
- Yes. Q40.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Q40.1 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 Q40.1?
- Q40.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.