Q64.12
BillableCloacal exstrophy of urinary bladder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q64.12 an HCC code?
No. Q64.12 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Q64.12 is the ICD-10-CM diagnosis code for cloacal exstrophy of urinary bladder. A severe birth defect where both the bladder and bowel are turned inside out and exposed through the abdominal wall. Q64.12 sits in the ICD-10-CM chapter for congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (q00-qa0), within the section covering congenital malformations of the urinary system (q60-q64).
Q64.12 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Cloacal exstrophy is the most severe form involving both urinary and intestinal structures.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q64.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Cloacal exstrophy is the most severe form involving both urinary and intestinal structures
- •Ensure documentation clearly indicates involvement of both bladder and bowel components