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FY2027 ICD-10-CM reference

Q21.20: Atrioventricular septal defect, unspecified as to partial or complete

By the HCC Buddy Coding Team

The official ICD-10-CM descriptor is Atrioventricular septal defect, unspecified as to partial or complete. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Billable code. Verified against the official FY2027 order file.

CMS-HCC V28

No V28 HCC for 2026 dates of service (CMS 2027 Initial ICD-10-CM Mappings)

CMS-HCC V24

Not used for payment year 2027 Medicare Advantage payment

ESRD

No category in the PY2026 CMS mapping; CMS 2027 initial file unchanged

PACE

Source verification pending

RxHCC

  • HCC 191: Ventricular Septal Defect and Major Congenital Heart Disorders

Coefficient pending: payment year 2027 coefficients for this model are not yet verified, so no RAF is shown. Mapping: PY2026 CMS mapping; CMS 2027 initial file unchanged.

HHS-HCC

Source verification pending

FY2027 Tabular instructions

Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.

Instructional note

Codes from this chapter are not for use on maternal records

Source: Q00-QA1 (chapter, inherited).

Excludes2

inborn errors of metabolism (E70-E88)

Source: Q00-QA1 (chapter, inherited).

Excludes1

acquired cardiac septal defect (I51.0)

Source: Q21 (category, inherited).

Instructional note

Atrioventricular canal defect

Source: Q21.2 (self, inherited).

Instructional note

Endocardial cushion defect

Source: Q21.2 (self, inherited).

Instructional note

Ostium primum atrial septal defect (type I)

Source: Q21.2 (self, inherited).

Instructional note

Atrioventricular canal, NOS

Source: Q21.20 (self, direct).

Instructional note

Endocardial cushion defect NOS

Source: Q21.20 (self, direct).

Instructional note

Ostium primum atrial septal defect (type I) NOS

Source: Q21.20 (self, direct).

Source: CMS FY2027 Tabular List and Alphabetic Index.

Open Tabular instructions and code details

Compare the FY2027 additions, removals and billable-status changes

What does Q21.20 mean in FY2027?

The official ICD-10-CM descriptor is Atrioventricular septal defect, unspecified as to partial or complete. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Is Q21.20 billable in FY2027?

The FY2027 order file marks Q21.20 as billable. Check the complete Tabular instructions and documentation before assigning it.

Does Q21.20 map to an HCC?

Q21.20 has no CMS-HCC V28 category in the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service). Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: no ESRD category; RxHCC HCC 191. Coefficients for these models are pending verification for payment year 2027. CMS-HCC V24, PACE and HHS-HCC mappings are still pending verification for FY2027.

Source: CMS FY2027 ICD-10-CM order file. Read the FY2027 Official Guidelines.

Review the FY2026 April edition