FY2027 ICD-10-CM reference
Q42.3: Congenital absence, atresia and stenosis of anus without fistula
By the HCC Buddy Coding Team
The official ICD-10-CM descriptor is Congenital absence, atresia and stenosis of anus without fistula. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Billable code. Verified against the official FY2027 order file.
FY2027 Tabular instructions
Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.
Instructional note
Codes from this chapter are not for use on maternal records
Source: Q00-QA1 (chapter, inherited).
Excludes2
inborn errors of metabolism (E70-E88)
Source: Q00-QA1 (chapter, inherited).
Includes
congenital obstruction, occlusion and stricture of large intestine
Source: Q42 (category, inherited).
Instructional note
Imperforate anus
Source: Q42.3 (self, direct).
Compare the FY2027 additions, removals and billable-status changes
What does Q42.3 mean in FY2027?
The official ICD-10-CM descriptor is Congenital absence, atresia and stenosis of anus without fistula. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Is Q42.3 billable in FY2027?
The FY2027 order file marks Q42.3 as billable. Check the complete Tabular instructions and documentation before assigning it.
Does Q42.3 map to an HCC?
In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), Q42.3 maps to CMS-HCC V28 HCC 78 (Intestinal Obstruction/Perforation). For 2027 dates of service, CMS has not yet published the payment year 2028 mappings. Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: no ESRD category; no RxHCC category. Coefficients for these models are pending verification for payment year 2027. HHS-HCC: HCC 45 under the HHS-HCC 2026 benefit year mapping (no RAF; HHS-HCC weights vary by metal level). CMS-HCC V24: not used for payment year 2027 Medicare Advantage payment (CMS CY 2027 Rate Announcement). The PACE mapping is still pending verification for FY2027.
Source: CMS FY2027 ICD-10-CM order file. Payment model: CMS CY 2027 Rate Announcement. Read the FY2027 Official Guidelines.
Review the FY2026 April edition