Q40.9 ICD-10-CM Code: Congenital malformation of upper alimentary tract, unspecified
HCC Buddy Code Card
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FY 2026 Apr update / Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0) / Other congenital malformations of the digestive system (Q38-Q45)
Q40.9
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCongenital malformation of upper alimentary tract, unspecified
A birth defect of the upper digestive tract where the specific type of malformation is not identified or documented.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Congenital anomaly of upper alimentary tract
- Congenital deformity of upper alimentary tract
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Q40.9 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Q40.9 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Q40.9 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Q40.9 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Q40.9 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Q40.9 in this effective period.
Buddy Documentation Tip
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 Q40.9 an HCC code?
No. Q40.9 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- Q40.9
- Description
- Congenital malformation of upper alimentary tract, unspecified
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Q40.9 is the ICD-10-CM diagnosis code for congenital malformation of upper alimentary tract, unspecified. A birth defect of the upper digestive tract where the specific type of malformation is not identified or documented. Q40.9 sits in the ICD-10-CM chapter for congenital malformations, deformations and chromosomal abnormalities (q00-qa0), within the section covering other congenital malformations of the digestive system (q38-q45).
Q40.9 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 is a default code; make every effort to obtain specific diagnostic information.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q40.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a default code; make every effort to obtain specific diagnostic information
- •Review imaging reports and clinical notes to identify the specific malformation