Q42.1

Billable

Congenital absence, atresia and stenosis of rectum without fistula

HCC Category Mapping

V28HCC 78 — Intestinal Obstruction/Perforation

0.000

What This Code Means

A birth defect where the rectum is completely absent, closed off, or abnormally narrowed without an abnormal opening, affecting bowel continuity.

Coding Tips

•Distinguish this code from Q42.0 by confirming the absence of a fistula in the documentation.
•Document the level of the rectal atresia (high, intermediate, or low) if specified, as this affects surgical approach.

Clinical Significance

Congenital rectal atresia without fistula represents a form of anorectal malformation that requires surgical reconstruction but may have better functional outcomes than cases with fistulas. Long-term management focuses on achieving continence and normal defecation patterns.

Documentation Requirements

✓Anatomic confirmation of rectal atresia without fistula
✓Level of atresia relative to pelvic muscles
✓Associated spinal and urogenital anomalies
✓Surgical approach and reconstruction technique
✓Colostomy management if performed
✓Post-operative continence assessment
✓Dietary and bowel management protocols
✓Long-term functional outcomes monitoring

Commonly Confused Codes

Q42.0 — Congenital rectal atresia with fistula (has fistula component)Q42.2 — Congenital anal atresia with fistula (anal level with fistula)Q42.3 — Congenital anal atresia without fistula (anal level without fistula)Q43.1 — Hirschsprung disease (functional vs anatomic obstruction)

Code Hierarchy

└Q42Congenital absence, atresia and stenosis of large intestine └Q42.1Congenital absence, atresia and stenosis of rectum without fistula

└Q42.1Congenital absence, atresia and stenosis of rectum without fistula