2026 ICD-10-CM Diagnosis Code Q38.6Other congenital malformations of mouth
ICD-10-CM Codes›Q00-Q99›Q38-Q45›Q38
- Billable — Valid for Submission
- POA Exempt
- Chronic Condition
Q38.6 is a billable ICD-10-CM diagnosis code for other congenital malformations of mouth. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 11 through 13, 157 through 159. 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
Q38.6 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.
- Brachymesophalangia
- Buccal bifurcation cyst
- Cleft palate lateral synechia syndrome
- Congenital abnormality of oral cavity
- Congenital absence of mouth
- Congenital anomaly of mouth
- Congenital anomaly of oral mucosa
- Congenital malformation of tongue, mouth and pharynx
- Cyst of oral soft tissue
- Ectopic oral gastrointestinal cyst
- Facial milia, lobate tongue, lingual and labial frenula syndrome
- Fordyce spots of buccal mucosa
- Fordyce spots of lips
- Fordyce's disease
- Frenal tag
- Gingival odontogenic cyst
- Hereditary mucoepithelial dysplasia
- Hypertrichosis with congenital macrogingivae
- Ichthyosis, oral and digital anomalies syndrome
- Inflammatory odontogenic cyst
- Melanin pigmentation of oral mucosa
- Melanosis of mucosa of body orifice
- Nail and tooth abnormalities, marginal palmoplantar keratoderma, oral hyperpigmentation syndrome
- Oral-facial-digital syndrome with short stature and brachymesophalangia
- Orofacial cleft
- Oro-facial digital syndrome type 11
- Oro-facial digital syndrome type 14
- Oro-facial digital syndrome type 5
- Wellesley Carman French syndrome
- White sponge nevus
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- Congenital malformation of mouth NOS
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Aberrant (congenital) See Also: Malposition, congenital;
Acheilia Q38.6
Aplasia See Also: Agenesis;
alveolar process (acquired) See: Anomaly, alveolar;
congenital Q38.6
Disease, diseased See Also: Syndrome;
Elongated, elongation (congenital) See Also: Distortion;
uvula Q38.6
lymph nodes Q38.6
neck structures Q38.6
fascia Q38.6
lymph nodes Q38.6
neck muscles Q38.6
Malformation (congenital) See Also: Anomaly;
gum Q38.6
mouth (congenital) Q38.6
white sponge Q38.6
white sponge Q38.6
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 Q38.6 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Q38.6Overview
What is the ICD-10 code for other congenital malformations of mouth?
The ICD-10-CM code for other congenital malformations of mouth is Q38.6 (sometimes written as Q386). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is Q38.6 (Other congenital malformations of tongue, mouth and pharynx) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other congenital malformations of mouth on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does Q38.6 group to?
When other congenital malformations of mouth is the principal diagnosis on an inpatient stay, it groups to MS-DRG 11, 12, 13, 157, 158, 159, with relative weights from 0.7085 to 5.4541 depending on complications. Higher weights mean higher Medicare reimbursement.
Is Q38.6 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 mouth on inpatient claims. The code appears in the Other congenital malformations of the digestive system (Q38-Q45) range of the CMS exempt list.
What is the ICD-9 equivalent of Q38.6?
Under the General Equivalence Mappings, other congenital malformations of mouth converts to ICD-9-CM 750.26 (mouth anomaly NEC). The mapping is approximate, so confirm the match fits the documentation.
