Q43.1

Q43.1: Hirschsprung's disease

Billable / specific codeICD-10-CMPOA exempt

Q43.1 is a billable, specific ICD-10-CM code for hirschsprung's disease. It is valid for submission on a claim.

Check Q43.1 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Aganglionosis
Congenital (aganglionic) megacolon

Other codes that can never be billed with Q43.1

Their own Excludes1 notes name this code, so the conflict is not listed above.

K59.3Megacolon, not elsewhere classified
P76.1Transitory ileus of newborn

Risk adjustment

Q43.1 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

Q43.1 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

Aganglionosis(bowel) (colon)
Hirschsprung's disease or megacolon
Macrocolon
Megacolon›congenital, congenitum(aganglionic)
Megacolon›Hirschsprung's(disease)
Dilatation›colon›congenital
Ileus›neurogenic›Hirschsprung's disease or megacolon
Obstruction, obstructed, obstructive›intestine›neurogenic›Hirschsprung's disease or megacolon

Code history

Unchanged in every release from FY2024 to FY2027.