ICD-10-CM Code Q42.3

Congenital absence, atresia and stenosis of anus without fistula

Version 2020 Billable Code POA Exempt

Valid for Submission

Q42.3 is a billable code used to specify a medical diagnosis of congenital absence, atresia and stenosis of anus without fistula. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code Q42.3 might also be used to specify conditions or terms like anal atresia, anal atresia, anal atresia, anal atresia, ankyloblepharon, ankyloblepharon filiforme adnatum, etc The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

ICD-10:Q42.3
Short Description:Congenital absence, atresia and stenosis of anus w/o fistula
Long Description:Congenital absence, atresia and stenosis of anus without fistula

Tabular List of Diseases and Injuries

The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code Q42.3:

Inclusion Terms

Inclusion Terms
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.
  • Imperforate anus

Index to Diseases and Injuries

The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code Q42.3 are found in the index:


Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • Anal atresia
  • Anal atresia
  • Anal atresia
  • Anal atresia
  • Ankyloblepharon
  • Ankyloblepharon filiforme adnatum
  • Ankyloblepharon filiforme adnatum with imperforate anus syndrome
  • Anorectal agenesis
  • Anorectal stricture
  • Anorectal stricture
  • Anus absent
  • Atresia and stenosis of large intestine, rectum and anal canal
  • Congenital absence of anus
  • Congenital ankyloblepharon
  • Congenital hemangioma
  • Congenital occlusion of anus
  • Congenital stricture of anus
  • Imperforate anus
  • Karandikar Maria Kamble syndrome
  • Low anorectal malformation
  • Low anorectal malformation
  • PELVIS syndrome
  • Spondylocostal dysostosis with anal atresia and genitourinary malformation syndrome
  • Stenosis of anal canal
  • Stricture of anal canal
  • Stricture of anus
  • Stricture of anus
  • VACTEL syndrome
  • VACTERL syndrome with hydrocephalus
  • Vertebral abnormalities, anal atresia, cardiac abnormalities, tracheo-esophageal fistula, renal anomalies, limb defects syndrome

Diagnostic Related Groups

The ICD-10 code Q42.3 is grouped in the following groups for version MS-DRG V37.0 What are Diagnostic Related Groups?
The Diagnostic Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats. The DRGs divides all possible principal diagnoses into mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories (MDC).
applicable from 10/01/2019 through 09/30/2020.

  • 393 - OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC
  • 394 - OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC
  • 395 - OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Present on Admission (POA)

Q42.3 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here .

CMS POA Indicator Options and Definitions
POA Indicator CodePOA Reason for CodeCMS will pay the CC/MCC DRG?
YDiagnosis was present at time of inpatient admission.YES
NDiagnosis was not present at time of inpatient admission.NO
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.NO
WClinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.YES
1Unreported/Not used - Exempt from POA reporting. NO

Convert Q42.3 to ICD-9

  • 751.2 - Atresia large intestine (Approximate Flag)

Code Classification

  • Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
    • Other congenital malformations of the digestive system (Q38-Q45)
      • Congenital absence, atresia and stenosis of large intestine (Q42)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


Anal Disorders

The anus is the opening of the rectum through which stool passes out of your body. Problems with the anus are common. They include hemorrhoids, abscesses, fissures (cracks), and cancer.

You may be embarrassed to talk about your anal troubles. But it is important to let your doctor know, especially if you have pain or bleeding. The more details you can give about your problem, the better your doctor will be able to help you. Treatments vary depending on the particular problem.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases


[Learn More]

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.

A birth defect may affect how the body looks, works or both. Some birth defects like cleft lip or neural tube defects are structural problems that can be easy to see. To find others, like heart defects, doctors use special tests. Birth defects can range from mild to severe. Causes can include

  • Genetics
  • Exposures to medicines or chemicals. For example, alcohol abuse can cause fetal alcohol syndrome.
  • Infections during pregnancy
  • Certain medicines. Before you get pregnant, talk to your health care provider about any medicines you take.
  • Not getting enough of certain nutrients. For example, not getting enough folic acid before and during pregnancy is a key factor in causing neural tube defects.

For most birth defects, the cause is unknown.

Health care providers can diagnose certain birth defects during pregnancy, with prenatal tests. That's why it important to get regular prenatal care. Other birth defects may not be found until after the baby is born. Sometimes the defect is obvious right away. Other times, the health care provider may not discover it until later in life.

Babies with birth defects often need special care and treatments. The treatments may include surgery, medicines, assistive devices, and therapies.

Centers for Disease Control and Prevention


[Learn More]