Q42.0: Congenital absence, atresia and stenosis of rectum with fistula

Risk adjustment

Q42.0 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 78 Intestinal Obstruction/Perforation0.326 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

Q42.0 is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A56421Billing and Coding: CT of the Abdomen and Pelvis
• A56456Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
• A56632Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy