Q41.9
BillableCongenital absence, atresia and stenosis of small intestine, part unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q41.9 an HCC code?
Yes. Q41.9 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 Q41.9
For Q41.9 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 Q41.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q41.9 is the ICD-10-CM diagnosis code for congenital absence, atresia and stenosis of small intestine, part unspecified. A birth defect involving absence, closure, or abnormal narrowing of the small intestine, but the specific segment affected is not documented or specified. Q41.9 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, Q41.9 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.000. Q41.9 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.
This is a less specific code; use only when the exact location of the small intestine defect cannot be determined from documentation. Because Q41.9 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 Q41.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a less specific code; use only when the exact location of the small intestine defect cannot be determined from documentation.
- •Query the provider if possible to obtain more specific anatomical location for more precise coding.
Clinical Significance
Unspecified small intestine atresia indicates the presence of congenital bowel obstruction but lacks the specific anatomic detail crucial for surgical planning and prognostic assessment. This condition still represents a serious neonatal surgical emergency requiring immediate intervention.
Documentation Requirements
- ✓Evidence of congenital small bowel obstruction
- ✓Surgical intervention details and findings
- ✓Attempts to characterize the specific location
- ✓Reason why specific segment cannot be determined
- ✓Post-operative recovery and complications
- ✓Nutritional management approach
- ✓Long-term follow-up plans
- ✓Associated congenital anomalies assessment