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Q42 ICD-10-CM Code: Congenital absence, atresia and stenosis of large intestine

Q42 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC coding software

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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)

Q42

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Congenital absence, atresia and stenosis of large intestine

Congenital absence, atresia and stenosis of large intestine

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

Official
Q4Other congenital malformations of the digestive system (Q38-Q45)
Q42Congenital absence, atresia and stenosis of large intestine

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for Q42 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for Q42 in this effective period.

Related Child Codes

Official
Q42.0Congenital absence, atresia and stenosis of rectum with fistula
Q42.1Congenital absence, atresia and stenosis of rectum without fistula
Q42.2Congenital absence, atresia and stenosis of anus with fistula
Q42.3Congenital absence, atresia and stenosis of anus without fistula
Q42.8Congenital absence, atresia and stenosis of other parts of large intestine

Includes

Official
  • congenital obstruction, occlusion and stricture of large intestine

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for Q42 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for Q42 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for Q42 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for Q42 in this effective period.

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 →

Code
Q42
Description
Congenital absence, atresia and stenosis of large intestine
HCC (V28)
No CMS-HCC V28 mapping
RAF
Billable
No
Payment year
2026

Coder workflow notes

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What This Code Means

Q42 is the ICD-10-CM diagnosis code for congenital absence, atresia and stenosis of large intestine. Q42 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).

Header codes like Q42 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at Q42's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q42 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Includes

  • congenital obstruction, occlusion and stricture of large intestine

Child Codes

Code Hierarchy

Q42Congenital absence, atresia and stenosis of large intestine
Q42Congenital absence, atresia and stenosis of large intestine

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