Q22.0 ICD-10-CM Code: Pulmonary valve atresia
Q22.0 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0) / Congenital malformations of the circulatory system (Q20-Q28)
Q22.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePulmonary valve atresia
A birth defect where the pulmonary valve is completely closed or absent, preventing blood flow from the right ventricle to the lungs.
Buddy Insight
Pulmonary valve atresia represents complete absence or closure of the pulmonary valve, preventing normal blood flow to the lungs and requiring immediate intervention for survival.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 138
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 191
RAF 0.150
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Q22.0 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Q22.0 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Q22.0 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Q22.0 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Q22.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Q22.0 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Q22.0 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is Q22.0 an HCC code?
Q22.0 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Congenital Heart/Circulatory Disorders and Fontan Circulation under the Part D RxHCC model.
- Code
- Q22.0
- Description
- Pulmonary valve atresia
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work Q22.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for Q22.0
For Q22.0 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed Q22.0 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
Q22.0 is the ICD-10-CM diagnosis code for pulmonary valve atresia. A birth defect where the pulmonary valve is completely closed or absent, preventing blood flow from the right ventricle to the lungs. Q22.0 sits in the ICD-10-CM chapter for congenital malformations, deformations and chromosomal abnormalities (q00-qa0), within the section covering congenital malformations of the circulatory system (q20-q28).
Q22.0 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing Q22.0 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q22.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a severe condition often requiring surgical intervention; look for associated codes for procedures or complications
- •May be associated with other cardiac defects; review for additional diagnoses
Clinical Significance
Pulmonary valve atresia represents complete absence or closure of the pulmonary valve, preventing normal blood flow to the lungs and requiring immediate intervention for survival. This condition necessitates complex surgical procedures to establish pulmonary circulation and requires lifelong cardiac management.
Documentation Requirements
- ✓Echocardiographic confirmation of absent or imperforate pulmonary valve
- ✓Assessment of right ventricular development and function
- ✓Evaluation of pulmonary artery size and development
- ✓Associated cardiac anomalies
- ✓Surgical intervention history and type of repair
- ✓Current oxygen saturation and cyanosis degree
- ✓Conduit function and need for replacement
- ✓Exercise tolerance and functional capacity