Q41.2
BillableCongenital absence, atresia and stenosis of ileum
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q41.2 an HCC code?
Yes. Q41.2 maps to Intestinal Obstruction/Perforation under the CMS-HCC V28 risk adjustment model.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for Q41.2
For Q41.2to 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 Q41.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q41.2 is the ICD-10-CM diagnosis code for congenital absence, atresia and stenosis of ileum. A birth defect where the ileum (the last part of the small intestine) is completely absent, closed off, or abnormally narrowed, impacting the final stage of nutrient absorption. Q41.2 sits in the ICD-10-CM chapter for congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (q00-qa0), within the section covering other congenital malformations of the digestive system (q38-q45).
Under the CMS-HCC V28 risk adjustment model, Q41.2 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.000. Q41.2 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Verify whether the condition affects the terminal ileum or extends proximally to other small bowel segments. Because Q41.2 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q41.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify whether the condition affects the terminal ileum or extends proximally to other small bowel segments.
- •Note any associated conditions such as meconium ileus or other intestinal anomalies in the documentation.
Clinical Significance
Congenital ileal atresia affects the terminal small intestine where crucial nutrients like vitamin B12 and bile acids are absorbed, potentially leading to specific nutritional deficiencies and malabsorption issues. Surgical repair must preserve as much functional bowel length as possible.
Documentation Requirements
- ✓Surgical confirmation of ileal atresia and location
- ✓Distance from ileocecal valve
- ✓Type of surgical repair performed
- ✓Assessment of remaining functional ileum
- ✓Post-operative nutritional and absorption studies
- ✓Vitamin B12 and bile acid metabolism evaluation
- ✓Associated ileocecal valve function
- ✓Long-term monitoring for malabsorption complications