Q44.2
BillableAtresia of bile ducts
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q44.2 an HCC code?
Yes. Q44.2 maps to Cholangitis and Biliary Cirrhosis 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 Q44.2
For Q44.2 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 Q44.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q44.2 is the ICD-10-CM diagnosis code for atresia of bile ducts. A birth defect where the bile ducts are completely closed or fail to develop, preventing bile from flowing to the intestines. Q44.2 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, Q44.2 maps to Cholangitis and Biliary Cirrhosis (HCC 68) with a community, non-dual, aged base RAF weight of 0.000. Q44.2 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.
Atresia of bile ducts is a serious condition often requiring surgical intervention. Because Q44.2 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 Q44.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Atresia of bile ducts is a serious condition often requiring surgical intervention
- •This code is distinct from stenosis (Q44.3) which involves narrowing rather than complete closure
Clinical Significance
Biliary atresia is a serious congenital condition requiring urgent surgical intervention (Kasai procedure) and often liver transplantation, making it one of the most common indications for pediatric liver transplant. Early recognition and treatment are crucial for survival, and these patients require lifelong specialized hepatology care with significant resource utilization.
Documentation Requirements
- ✓Confirmation of complete absence or closure of bile ducts
- ✓Type of biliary atresia (extrahepatic, intrahepatic, or mixed)
- ✓Liver biopsy findings showing bile duct absence
- ✓Associated complications (cirrhosis, portal hypertension)
- ✓Surgical interventions (Kasai portoenterostomy, liver transplant)
- ✓Current liver function status and laboratory values
- ✓Jaundice progression and bilirubin levels