Q42.8 — Congenital absence, atresia and stenosis of other parts of large intestine
Q42.8 is a billable, specific ICD-10-CM code for congenital absence, atresia and stenosis of other parts of large intestine. It is valid for submission on a claim.
Risk adjustment
Q42.8 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
Q42.8 is named in 4 Medicare coverage policies — 4 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
- A57342Billing and Coding: Diagnostic and Therapeutic Colonoscopy
How Q42.8 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 Q42.8.
- Absence›appendix, congenital
- Agenesis›appendix
- Agenesis›cecum
- Atresia, atretic›cecum
- Hypoplasia, hypoplastic›cecum
- Agenesis›colon›specified NEC
- Atresia, atretic›colon›specified NEC
- Hypoplasia, hypoplastic›colon›specified NEC
- Agenesis›intestine›large›specified NEC
- Atresia, atretic›intestine›large›specified NEC
- Hypoplasia, hypoplastic›intestine›large›specified NEC
- Impervious›intestine›large›specified NEC
Related codes at this level
Codes that share Q42. If Q42.8 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
- Q42.2Congenital absence, atresia and stenosis of anus with fistula
- Q42.3Congenital absence, atresia and stenosis of anus without fistula
- Q42.9Congenital absence, atresia and stenosis of large intestine, part unspecified
Questions about Q42.8
- Is Q42.8 a billable ICD-10-CM code?
- Yes. Q42.8 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Q42.8 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).