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Q43 ICD-10-CM Code: Other congenital malformations of intestine

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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)

Q43

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

Other congenital malformations of intestine

Other congenital malformations of intestine

CMS-HCC V28

0

0

RAF 0

CMS-HCC V24

0

0

RAF 0

ACA/HHS

0

0

RAF 0

ESRD/PACE

0

0

RAF 0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
Q4Other congenital malformations of the digestive system (Q38-Q45)
Q43Other congenital malformations of intestine

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for Q43 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for Q43 in this effective period.

Related Child Codes

Official
Q43.0Meckel's diverticulum (displaced) (hypertrophic)
Q43.1Hirschsprung's disease
Q43.2Other congenital functional disorders of colon
Q43.3Congenital malformations of intestinal fixation
Q43.4Duplication of intestine

Includes

Official

ICD-10-CM does not list Includes notes for Q43 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for Q43 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for Q43 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for Q43 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for Q43 in this effective period.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

What This Code Means

Q43 is the ICD-10-CM diagnosis code for other congenital malformations of intestine. Q43 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 Q43 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 Q43'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 Q43 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Child Codes

Code Hierarchy

Q43Other congenital malformations of intestine
Q43Other congenital malformations of intestine

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