2026 ICD-10-CM Diagnosis Code Q38.5Congenital malformations of palate, not elsewhere classified

ICD-10-CM Codes›Q00-Q99›Q38-Q45›Q38

ICD-10-CM Q38.5
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

Q38.5 is a billable ICD-10-CM diagnosis code for congenital malformations of palate, not elsewhere classified. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 393 through 395. The code is exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Digestive congenital anomalies.

Code Identity

ICD-10-CM Code
Q38.5
Billable Status
Yes — Valid for Submission
Code Describes
Congenital malformations of palate, not elsewhere classified
Short Description
Congenital malformations of palate, not elsewhere classified
Same as the full description in the CMS dataset.
Parent Code
Q38
Other congenital malformations of tongue, mouth and pharynx

Code Classification

ChapterQ00-Q99Congenital malformations, deformations and chromosomal abnormalities
SectionQ38-Q45Other congenital malformations of the digestive system
CategoryQ38Other congenital malformations of tongue, mouth and pharynx
This CodeQ38.5Congenital malformations of palate, not elsewhere classified

Present on Admission (POA)Billing

Q38.5 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.

  • Absence of uvula
  • Agenesis of soft palate
  • Byzanthine arch palate
  • Congenital abnormal fusion of palatine bone
  • Congenital abnormal shape of palate rugae
  • Congenital abnormal shape of palatine bone
  • Congenital absence of palatine bone
  • Congenital absence of soft palate
  • Congenital absence of uvula
  • Congenital anomaly of palate
  • Congenital anomaly of palatine bone
  • Congenital anomaly of uvula
  • Congenital hypoplasia of palatine bone
  • Congenital malposition of palate rugae
  • Congenital misalignment of palate rugae
  • Congenital short hard palate
  • Deviation of uvula
  • Flat palate
  • Oculopalatocerebral syndrome
  • Palatal anomalies, widely spaced teeth, facial dysmorphism, developmental delay syndrome
  • Persistent hyperplastic primary vitreous
  • RAPADILINO syndrome
  • Redundant soft palate

Tabular List NotesGuidance

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

Inclusion Terms

  • Congenital absence of uvula
  • Congenital malformation of palate NOS
  • Congenital high arched palate

Type 1 Excludes

  • cleft palate Q35
  • cleft palate with cleft lip Q37

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)
      • uvula, congenital
    • Agenesis
      • uvula
    • Anomaly, anomalous(congenital) (unspecified type)
      • palate (hard) (soft) NEC
    • Anomaly, anomalous(congenital) (unspecified type)
      • uvula
    • Deformity
      • palate (congenital)
    • Deformity
      • uvula (congenital)
    • Flaccid
      • palate, congenital
    • High
      • arch
        • palate, congenital
    • High
      • palate, congenital
    • Malformation(congenital)
      • palate
    • Short, shortening, shortness
      • palate, congenital
    • Short, shortening, shortness
      • uvula, congenital

Clinical ClassificationClinical

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

CCSR MAL002
Digestive congenital anomalies
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Persistent Hyperplastic Primary Vitreous

    a developmental ocular anomaly in which the primary vitreous body and its surrounding hyaloid vasculature failed to regress. it is usually unilateral and characterized by cataract; microphthalmos (small eyeballs), and retrolenticular fibrovascular tissue. (from yanoff: ophthalmology, 2nd ed.)

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 Q38.5 to ICD-9-CMHistory

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

ICD-9-CM
750.9 Upper GI anomaly NOS
Approximate The match is approximate rather than exact.

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 Q38.5Overview

Is Q38.5 (Other congenital malformations of tongue, mouth and pharynx) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report congenital malformations of palate, not elsewhere classified on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does Q38.5 group to?

When congenital malformations of palate, not elsewhere classified is the principal diagnosis on an inpatient stay, it groups to MS-DRG 393, 394, 395, with relative weights from 0.6490 to 1.5993 depending on complications. Higher weights mean higher Medicare reimbursement.

Is Q38.5 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 congenital malformations of palate, not elsewhere classified on inpatient claims.

What is the ICD-9 equivalent of Q38.5?

Under the General Equivalence Mappings, congenital malformations of palate, not elsewhere classified converts to ICD-9-CM 750.9 (upper GI anomaly NOS). The mapping is approximate, so confirm the match fits the documentation.

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.