2027 ICD-10-CM Diagnosis Code Q38.5Congenital malformations of palate, not elsewhere classified
ICD-10-CM Codes›Q00-Q99›Q38-Q45›Q38
- Billable — Valid for Submission
- POA Exempt
- Chronic Condition
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 2027 (October 1, 2026 through September 30, 2027) 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
Code Classification
Present on Admission (POA)Billing
Q38.5 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Other congenital malformations of the digestive system (Q38-Q45).
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
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Q38.5: its own notes plus those printed at Q38 and Chapter 17. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Congenital absence of uvula
- Congenital malformation of palate NOS
- Congenital high arched palate
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
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.
Notes
General instructions on how these codes are used.
- Codes from this chapter are not for use on maternal records
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
palate (congenital) Q38.5
uvula (congenital) Q38.5
Flaccid See Also: condition;
palate, congenital Q38.5
palate, congenital Q38.5
palate, congenital Q38.5
Malformation (congenital) See Also: Anomaly;
palate Q38.5
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
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.
Code HistoryHistory
Questions About Q38.5Overview
What is the ICD-10 code for congenital malformations of palate, not elsewhere classified?
The ICD-10-CM code for congenital malformations of palate, not elsewhere classified is Q38.5 (sometimes written as Q385). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
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, 2026 through September 30, 2027.
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 394, 395, 393, with relative weights from 0.6379 to 1.5877 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. The code appears in the Other congenital malformations of the digestive system (Q38-Q45) range of the CMS exempt list.
Can Q38.5 be reported with a code from Q35?
Not as a rule. The Excludes1 note on Q38.5 lists "cleft palate (Q35.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
