Is Q43.1 a billable ICD-10-CM code?

Yes. Q43.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Q43.1 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).

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.

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

These codes carry an Excludes1 note pointing at Q43.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading Q43.1 alone.

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

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.

Medicare coverage

Q43.1 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 Q43.1 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 Q43.1.

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

Related codes at this level

Codes that share Q43. If Q43.1 is not quite right, the correct code is usually one of these.

Questions about Q43.1

Is Q43.1 a billable ICD-10-CM code?: Yes. Q43.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Q43.1 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).