Q42.2 — Congenital absence, atresia and stenosis of anus with fistula
Q42.2 is a billable, specific ICD-10-CM code for congenital absence, atresia and stenosis of anus with fistula. It is valid for submission on a claim.
Other codes that can never be billed with Q42.2
These codes carry an Excludes1 note pointing at Q42.2. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading Q42.2 alone.
- Q43.6Congenital fistula of rectum and anus
Risk adjustment
Q42.2 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.
Medicare coverage
Q42.2 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.
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A56456Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
- A56632Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
How Q42.2 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 Q42.2.
- Absence›anus›with fistula
- Agenesis›anus, anal›with fistula
- Atresia, atretic›ani, anus, anal›with fistula
- Hypoplasia, hypoplastic›anus, anal›with fistula
- Imperforate›anus›with fistula
- Impervious›anus›with fistula
- Persistence, persistent›anal membrane›with fistula
- Septum, septate›anal›with fistula
- Fistula›anus, anal›congenital›with absence, atresia and stenosis
- Occlusion, occluded›anus›congenital›with fistula
- Stenosis, stenotic›anus, anal›congenital›with fistula
- Stricture›anus›congenital›with fistula
Related codes at this level
Codes that share Q42. If Q42.2 is not quite right, the correct code is usually one of these.
- Q42.0Congenital absence, atresia and stenosis of rectum with fistula
- Q42.1Congenital absence, atresia and stenosis of rectum without 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
Questions about Q42.2
- Is Q42.2 a billable ICD-10-CM code?
- Yes. Q42.2 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Q42.2 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).