Question 1

What is ICD-10 code Q64.31?

Accepted Answer

Q64.31 is the ICD-10-CM diagnosis code for congenital bladder neck obstruction. A birth defect where the opening of the bladder into the urethra is abnormally narrowed or blocked. Q64.31 sits in the ICD-10-CM chapter for congenital malformations, deformations and chromosomal abnormalities (q00-qa0), within the section covering congenital malformations of the urinary system (q60-q64).

Q64.31 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28, V24, ESRD, or RxHCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

This obstruction occurs at the bladder neck junction; distinguish from urethral stricture (Q64.32).

Question 2

Is Q64.31 an HCC code?

Accepted Answer

Q64.31 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 3

Is Q64.31 billable?

Accepted Answer

Yes. Q64.31 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. Q64.31 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

Which HCC does Q64.31 map to under V28?

Accepted Answer

Q64.31 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

Question 5

What RAF reference is published for Q64.31?

Accepted Answer

Q64.31 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

Question 6

What is the V28 vs V24 difference for Q64.31?

Accepted Answer

Q64.31 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

Question 7

What documentation supports Q64.31?

Accepted Answer

This obstruction occurs at the bladder neck junction; distinguish from urethral stricture (Q64.32) Document degree of obstruction and any associated hydronephrosis or renal complications Q64.31 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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Q64.31

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Q64.31 ICD-10-CM Code: Congenital bladder neck obstruction

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Q64.31

Is Q64.31 an HCC code?

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