Q42.1
Q42.1: Congenital absence, atresia and stenosis of rectum without fistula
Billable / specific codeICD-10-CMPOA exempt
Q42.1 is a billable, specific ICD-10-CM code for congenital absence, atresia and stenosis of rectum without fistula. It is valid for submission on a claim.
Check Q42.1 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Imperforate rectum
Risk adjustment
Q42.1 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
Q42.1 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
Alphabetic index entries that lead here
- Absence›rectum(congenital)
- Agenesis›rectum
- Atresia, atretic›rectum
- Hypoplasia, hypoplastic›rectum
- Imperforate›rectum
- Impervious›rectum
- Stricture›rectum›congenital
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under Q42
- Q42.0Congenital absence, atresia and stenosis of rectum with 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