Is Q43.6 a billable ICD-10-CM code?

Yes. Q43.6 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Q43.6 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).

What cannot be coded together with Q43.6?

Q43.6 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

Q43.6

Q43.6 — Congenital fistula of rectum and anus

Billable / specific codeICD-10-CMPOA exempt

Q43.6 is a billable, specific ICD-10-CM code for congenital fistula of rectum and anus. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

congenital fistula of anus with absence, atresia and stenosis (Q42.2)
congenital fistula of rectum with absence, atresia and stenosis (Q42.0)
congenital rectovaginal fistula (Q52.2)
congenital urethrorectal fistula (Q64.73)
pilonidal fistula or sinus (L05.-)

Other codes that can never be billed with Q43.6

These codes carry an Excludes1 note pointing at Q43.6. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading Q43.6 alone.

K60.3Anal fistula
K60.4Rectal fistula
K60.5Anorectal fistula

Risk adjustment

Q43.6 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

Q43.6 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 Q43.6 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 Q43.6.

Fistula›anus, anal›congenital
Fistula›fecal›congenital
Fistula›rectum›congenital

Related codes at this level

Codes that share Q43. If Q43.6 is not quite right, the correct code is usually one of these.

Questions about Q43.6

Is Q43.6 a billable ICD-10-CM code?: Yes. Q43.6 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Q43.6 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).
What cannot be coded together with Q43.6?: Q43.6 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.