2026 ICD-10-CM Diagnosis Code Q38.7Congenital pharyngeal pouch

ICD-10-CM Codes›Q00-Q99›Q38-Q45›Q38

ICD-10-CM Q38.7
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

Q38.7 is a billable ICD-10-CM diagnosis code for congenital pharyngeal pouch. 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 diverticulum of pharynx. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Digestive congenital anomalies.

Code Identity

ICD-10-CM Code
Q38.7
Billable Status
Yes — Valid for Submission
Code Describes
Congenital pharyngeal pouch
Short Description
Congenital pharyngeal pouch
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 CodeQ38.7Congenital pharyngeal pouch

Present on Admission (POA)Billing

Q38.7 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 diverticulum of pharynx

Tabular List NotesGuidance

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

Inclusion Terms

  • Congenital diverticulum of pharynx

Type 1 Excludes

  • pharyngeal pouch syndrome D82.1

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.

    • Diverticulum, diverticula(multiple)
      • pharynx (congenital)
    • Pouch
      • pharynx, pharyngeal (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

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 Q38.7 to ICD-9-CMHistory

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

ICD-9-CM
750.27 Diverticulum of pharynx
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 Q38.7Overview

Is Q38.7 (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 pharyngeal pouch on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does Q38.7 group to?

When congenital pharyngeal pouch 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 Q38.7 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 pharyngeal pouch on inpatient claims.

What is the ICD-9 equivalent of Q38.7?

Under the General Equivalence Mappings, congenital pharyngeal pouch converts to ICD-9-CM 750.27 (diverticulum of pharynx). 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.