Q79.0 ICD-10-CM Code: Congenital diaphragmatic hernia
Q79.0 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0) / Congenital malformations and deformations of the musculoskeletal system (Q65-Q79)
Q79.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCongenital diaphragmatic hernia
A birth defect where there is an abnormal opening in the diaphragm (the muscle that separates the chest from the abdomen), allowing abdominal organs to move into the chest cavity.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 64
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Q79.0 in this effective period.
Excludes 2
Official- congenital (sternomastoid) torticollis (Q68.0)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Q79.0 in this effective period.
Excludes 1
Official- congenital hiatus hernia (Q40.1)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Q79.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Q79.0 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Q79.0 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is Q79.0 an HCC code?
No. Q79.0 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- Q79.0
- Description
- Congenital diaphragmatic hernia
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Q79.0 is the ICD-10-CM diagnosis code for congenital diaphragmatic hernia. A birth defect where there is an abnormal opening in the diaphragm (the muscle that separates the chest from the abdomen), allowing abdominal organs to move into the chest cavity. Q79.0 sits in the ICD-10-CM chapter for congenital malformations, deformations and chromosomal abnormalities (q00-qa0), within the section covering congenital malformations and deformations of the musculoskeletal system (q65-q79).
Q79.0 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.
Specify the side of the defect (left, right, or bilateral) if documented, as this may affect code selection in some coding systems.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q79.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify the side of the defect (left, right, or bilateral) if documented, as this may affect code selection in some coding systems
- •Note whether the hernia was repaired during the encounter, as this may require an additional procedure code
Excludes 1, Do NOT code together
- congenital hiatus hernia (Q40.1)