ICD-10 Diagnosis Code Q43.6

Congenital fistula of rectum and anus

Diagnosis Code Q43.6

ICD-10: Q43.6
Short Description: Congenital fistula of rectum and anus
Long Description: Congenital fistula of rectum and anus
This is the 2019 version of the ICD-10-CM diagnosis code Q43.6

Valid for Submission
The code Q43.6 is valid for submission for HIPAA-covered transactions.

Code Classification
  • Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
    • Other congenital malformations of the digestive system (Q38-Q45)
      • Other congenital malformations of intestine (Q43)

Information for Medical Professionals

Diagnostic Related Groups
The diagnosis code Q43.6 is grouped in the following Diagnostic Related Group(s) (MS-DRG V35.0)

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

Convert to ICD-9
  • 751.5 - Intestinal anomaly NEC (Approximate Flag)

Present on Admission (POA)
The code Q43.6 is exempt from POA reporting.

Synonyms
  • Congenital anoperineal fistula
  • Congenital fecal fistula
  • Congenital fistula of anus
  • Congenital fistula of intestinal tract
  • Congenital fistula of intestinal tract
  • Congenital fistula of rectum
  • Congenital fistula of rectum and anus
  • Enterocutaneous fistula

Index of Diseases and Injuries
References found for the code Q43.6 in the Index of Diseases and Injuries:

  • Type 1 Excludes Notes:
    • congenital fistula of anus WITH absence, atresia and stenosis (Q42.2)
    • congenital fistula of rectum WITH absence, atresia and stenosis (Q42.0)
    • congenital rectovaginal fistula (Q52.2)
    • congenital urethrorectal fistula (Q64.73)
    • pilonidal fistula or sinus (L05.-)

Information for Patients


Anal Disorders

Also called: Anorectal diseases

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

  • Anal fissure (Medical Encyclopedia)
  • Anal itching -- self-care (Medical Encyclopedia)
  • Anorectal abscess (Medical Encyclopedia)
  • Anoscopy (Medical Encyclopedia)
  • Digital rectal exam (Medical Encyclopedia)
  • Imperforate anus (Medical Encyclopedia)
  • Lower GI Series - NIH (National Institute of Diabetes and Digestive and Kidney Diseases)
  • Perianal streptococcal cellulitis (Medical Encyclopedia)

[Read More]

Fistulas

A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between the esophagus and the windpipe or the bowel and the vagina. They can also develop between two blood vessels, such as between an artery and a vein or between two arteries.

Some people are born with a fistula. Other common causes of fistulas include

  • Complications from surgery
  • Injury
  • Infection
  • Diseases, such as Crohn's disease or ulcerative colitis

Treatment depends on the cause of the fistula, where it is, and how bad it is. Some fistulas will close on their own. In some cases, you may need antibiotics and/or surgery.

  • Fistula (Medical Encyclopedia)
  • Gastrointestinal fistula (Medical Encyclopedia)

[Read More]

Rectal Disorders

The rectum is the lower part of your large intestine where your body stores stool. Problems with rectum are common. They include hemorrhoids, abscesses, incontinence and cancer.

Many people are embarrassed to talk about rectal troubles. But seeing your doctor about problems in this area is important. This is especially true if you have pain or bleeding. Treatments vary depending on the particular problem.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

  • Anorectal abscess (Medical Encyclopedia)
  • Digital rectal exam (Medical Encyclopedia)
  • Lower GI Series - NIH (National Institute of Diabetes and Digestive and Kidney Diseases)
  • Proctitis (Medical Encyclopedia)
  • Rectal biopsy (Medical Encyclopedia)
  • Rectal prolapse (Medical Encyclopedia)
  • Rectal prolapse repair (Medical Encyclopedia)

[Read More]

ICD-10 Footnotes

General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.

  • Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
  • No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
  • Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.

Index of Diseases and Injuries Definitions

  • And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
  • Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
  • Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
  • Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
  • Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
  • Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
  • Inclusion terms - List of terms is included under some codes. 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.
  • NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
  • NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
  • See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
  • See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
  • 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
  • With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.

Present on Admission
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.

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