2027 ICD-10-CM Diagnosis Code Q22.0Pulmonary valve atresia

ICD-10-CM Codes›Q00-Q99›Q20-Q28›Q22

ICD-10-CM Q22.0
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

Q22.0 is a billable ICD-10-CM diagnosis code for pulmonary valve atresia. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 306 through 307. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 62 closely related codes. The code is exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Cardiac and circulatory congenital anomalies.

Q22.0 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 191 for payment year 2027.

Code Identity

ICD-10-CM Code
Q22.0
Billable Status
Yes — Valid for Submission
Code Describes
Pulmonary valve atresia
Short Description
Pulmonary valve atresia
Same as the full description in the CMS dataset.
Parent Code
Q22
Congenital malformations of pulmonary and tricuspid valves

Code Classification

ChapterQ00-Q99Congenital malformations, deformations and chromosomal abnormalities
SectionQ20-Q28Congenital malformations of the circulatory system
CategoryQ22Congenital malformations of pulmonary and tricuspid valves
This CodeQ22.0Pulmonary valve atresia

Present on Admission (POA)Billing

Q22.0 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Congenital malformations of the circulatory system (Q20-Q28).

Medicare Risk Adjustment (HCC)Billing

Q22.0 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model, but it maps to payment categories in the other CMS models shown below.

CMS-HCC V28 (Medicare Advantage Payment Model)
Not mapped
no payment category in the model that pays 100% of MA risk scores
Prior Model (CMS-HCC V24)
Not mapped under V24
this diagnosis newly risk-adjusts under the V28 model
Part D (RxHCC)
RxHCC 191 — Ventricular Septal Defect and Major Congenital Heart Disorders
also risk-adjusts in the Part D prescription drug model (V08)

Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Absence of pulmonary valve cusp
  • Absent pulmonary valve syndrome
  • Absent pulmonary valve syndrome with ventricular septal defect of non Fallot type
  • Agenesis of artery
  • Atresia of pulmonary valve
  • Congenital abnormality of thoracic aorta and pulmonary arteries
  • Congenital absence of ductus arteriosus
  • Congenital absence of pulmonary valve
  • Congenital atresia of pulmonary valve
  • Congenital hypoplasia of pulmonary valve
  • Dilatation of tricuspid annulus
  • Ebstein anomaly of tricuspid valve with functional pulmonary valve atresia
  • Ebstein's anomaly
  • Hypoplasia of pulmonary cusps of absent pulmonary valve type
  • Hypoplasia of pulmonary valve
  • Muscular pulmonary atresia
  • Patent ductus arteriosus
  • Pulmonary atresia and ventricular septal defect with aorta from left ventricle
  • Pulmonary atresia and ventricular septal defect with aorta from right ventricle
  • Pulmonary atresia with intact ventricular septum
  • Pulmonary atresia with ventricular septal defect
  • Pulmonary atresia with ventricular septal defect of Fallot type
  • Pulmonary valve agenesis, intact ventricular septum, persistent ductus arteriosus syndrome
  • Pulmonary valve agenesis, tetralogy of Fallot, absence of ductus arteriosus syndrome
  • Pulmonary valve atresia without ventricular outflow tract
  • Pulmonary valve cusp hypoplasia
  • Tetralogy of Fallot
  • Tetralogy of Fallot with absent pulmonary valve
  • Tetralogy of Fallot with atresia of pulmonary valve
  • Tetralogy of Fallot with pulmonary atresia and systemic-to-pulmonary collateral artery
  • Tricuspid leaflet fenestration

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to Q22.0: its own notes plus those printed at Chapter 17. A note printed at a category, block or chapter applies to every code under it.

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Chapter 17 (Q00-QA1) Congenital malformations, deformations and chromosomal abnormalities applies to 900 codes
  • inborn errors of metabolism (E70-E88)

Notes

General instructions on how these codes are used.

From Chapter 17 (Q00-QA1) Congenital malformations, deformations and chromosomal abnormalities applies to 900 codes
  • Codes from this chapter are not for use on maternal records

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name Q22.0, its category, or a range that includes it.

Excludes2 1

These codes carry an Excludes2 note naming Q22.0: its condition is not part of those codes, and both may be reported when the patient has both.

  • I08 Multiple valve diseases
    multiple valve disease specified as nonrheumatic (I34.-, I35.-, I36.-, I37.-, I38.-, Q22.-, Q23.-, Q24.8-) names Q22.-, which includes this code

Use Additional Code 1

These codes say to use an additional code from the note, and Q22.0 is one of the codes named.

  • Q87.88 CTNNB1 syndrome
    congenital heart malformations (Q20.0-Q24.9) names Q20.0-Q24.9, which includes this code

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

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

CCSR MAL001
Cardiac and circulatory congenital anomalies
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Pulmonary Atresia

    a congenital heart defect characterized by the narrowing or complete absence of the opening between the right ventricle and the pulmonary artery. lacking a normal pulmonary valve, unoxygenated blood in the right ventricle can not be effectively pumped into the lung for oxygenation. clinical features include rapid breathing, cyanosis, right ventricle atrophy, and abnormal heart sounds (heart murmurs).

Patient EducationClinical

Congenital Heart Defects

Congenital heart defects (CHDs) are problems with the structure of the heart. "Congenital" means that that the problems are present at birth. These defects happen when a fetus's heart doesn't develop normally during pregnancy. Congenital heart defects are the most common type of birth defect.

The full article covers:

  • What are congenital heart defects?
  • What causes congenital heart defects?
  • Who is more likely to have a baby with a congenital heart defect?
  • What are the symptoms of congenital heart defects?
  • What other problems do congenital heart defects cause?
  • How are congenital heart defects diagnosed?
  • What are the treatments for congenital heart defects?

Read the full article at MedlinePlus

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

Convert Q22.0 to ICD-9-CMHistory

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

ICD-9-CM
746.01 Cong pulmon valv atresia
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 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About Q22.0Overview

What is the ICD-10 code for pulmonary valve atresia?

The ICD-10-CM code for pulmonary valve atresia is Q22.0 (sometimes written as Q220). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is Q22.0 (Congenital malformations of pulmonary and tricuspid valves) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report pulmonary valve atresia on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does Q22.0 group to?

When pulmonary valve atresia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 306, 307, with relative weights from 0.9146 to 1.5457 depending on complications. Higher weights mean higher Medicare reimbursement.

Is Q22.0 a CC or MCC?

CMS lists Q22.0 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 62 closely related codes in its exclusion list.

Is Q22.0 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 pulmonary valve atresia on inpatient claims. The code appears in the Congenital malformations of the circulatory system (Q20-Q28) range of the CMS exempt list.

Does Q22.0 risk-adjust for Medicare Advantage payment?

Not for Medicare Advantage: Q22.0 maps to no category in the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 191 (Ventricular Septal Defect and Major Congenital Heart Disorders).