2026 ICD-10-CM Diagnosis Code Q16.4Other congenital malformations of middle ear

ICD-10-CM Codes›Q00-Q99›Q10-Q18›Q16

ICD-10-CM Q16.4
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

Q16.4 is a billable ICD-10-CM diagnosis code for other congenital malformations of middle ear. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 154 through 156. The code is exempt from POA reporting. Coders also document this condition as congenital anomaly of middle ear. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Congenital malformations of eye, ear, face, neck.

Code Identity

ICD-10-CM Code
Q16.4
Billable Status
Yes — Valid for Submission
Code Describes
Other congenital malformations of middle ear
Short Description
Other congenital malformations of middle ear
Same as the full description in the CMS dataset.
Parent Code
Q16
Congenital malformations of ear causing impairment of hearing

Code Classification

ChapterQ00-Q99Congenital malformations, deformations and chromosomal abnormalities
SectionQ10-Q18Congenital malformations of eye, ear, face and neck
CategoryQ16Congenital malformations of ear causing impairment of hearing
This CodeQ16.4Other congenital malformations of middle ear

Present on Admission (POA)Billing

Q16.4 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review other POA exempt codes.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Congenital anomaly of middle ear
  • Congenital malformation of left middle ear
  • Congenital malformation of right middle ear

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

  • Congenital malformation of middle ear NOS

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Absence(of) (organ or part) (complete or partial)
      • ear, congenital
        • middle, except ossicles
    • Absence(of) (organ or part) (complete or partial)
      • osseous meatus (ear)
    • Anomaly, anomalous(congenital) (unspecified type)
      • ear (external)
        • middle (causing impairment of hearing)
    • Anomaly, anomalous(congenital) (unspecified type)
      • middle ear
    • Deformity
      • ear (acquired)
        • congenital (external)
          • middle
    • Deformity
      • middle ear (congenital)
    • Distortion(s) (congenital)
      • ear (auricle) (external)
        • middle
    • Hypoplasia, hypoplastic
      • ear (auricle) (lobe)
        • middle
    • Imperfect
      • closure (congenital)
        • ear drum (causing impairment of hearing)
    • Imperfect
      • closure (congenital)
        • tympanic membrane (causing impairment of hearing)
    • Maldevelopment
      • middle ear
    • Maldevelopment
      • middle ear
        • except ossicles
    • Malformation(congenital)
      • ear
        • middle
    • Malformation(congenital)
      • middle ear

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR MAL005
Congenital malformations of eye, ear, face, neck
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Birth Defects

A birth defect is a problem that happens while a baby is developing in the mother's body. Most birth defects happen during the first 3 months of pregnancy. One out of every 33 babies in the United States is born with a birth defect.

The full article covers:

  • What are birth defects?
  • What causes birth defects?
  • Who is at risk of having a baby with birth defects?
  • How are birth defects diagnosed?
  • What are the treatments for birth defects?
  • Can birth defects be prevented?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert Q16.4 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
744.03 Middle ear anomaly NEC
Exact Match The mapping is direct, with no qualifiers.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About Q16.4Overview

Is Q16.4 a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report other congenital malformations of middle ear on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does Q16.4 group to?

When other congenital malformations of middle ear is the principal diagnosis on an inpatient stay, it groups to MS-DRG 154, 155, 156, with relative weights from 0.6911 to 1.5635 depending on complications. Higher weights mean higher Medicare reimbursement.

Is Q16.4 exempt from POA reporting?

Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for other congenital malformations of middle ear on inpatient claims.

What is the ICD-9 equivalent of Q16.4?

Under the General Equivalence Mappings, other congenital malformations of middle ear converts to ICD-9-CM 744.03 (middle ear anomaly NEC). The mapping is a direct match.

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

  • The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
  • The condition places limitations on self-care, independent living, and social interactions.