2021 ICD-10-CM Code Q43.6
Congenital fistula of rectum and anus
Valid for Submission
Q43.6 is a billable diagnosis code used to specify a medical diagnosis of congenital fistula of rectum and anus. The code Q43.6 is valid during the fiscal year 2021 from October 01, 2020 through September 30, 2021 for the submission of HIPAA-covered transactions.
The ICD-10-CM code Q43.6 might also be used to specify conditions or terms like anorectal fistula, congenital anoperineal fistula, congenital fecal fistula, congenital fistula of anus, congenital fistula of rectum , congenital fistula of rectum and anus, etc. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
ICD-10: | Q43.6 |
Short Description: | Congenital fistula of rectum and anus |
Long Description: | Congenital fistula of rectum and anus |
Code Classification
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 Q43.6:
Type 1 Excludes
Type 1 ExcludesA 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.
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 Q43.6 are found in the index:
- - Fistula (cutaneous) - L98.8
- - anus, anal (recurrent) (infectional) - K60.3
- - congenital - Q43.6
- - fecal - K63.2
- - congenital - Q43.6
- - rectum (to skin) - K60.4
- - congenital - Q43.6
- - anus, anal (recurrent) (infectional) - K60.3
Approximate Synonyms
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:
- Anorectal fistula
- Congenital anoperineal fistula
- Congenital fecal fistula
- Congenital fistula of anus
- Congenital fistula of rectum
- Congenital fistula of rectum and anus
- Enterocutaneous fistula
Diagnostic Related Groups - MS-DRG Mapping
The ICD-10 code Q43.6 is grouped in the following groups for version MS-DRG V38.0 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 10/01/2020 through 09/30/2021.
Present on Admission (POA)
Q43.6 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 Code | POA Reason for Code | CMS will pay the CC/MCC DRG? |
---|---|---|
Y | Diagnosis was present at time of inpatient admission. | YES |
N | Diagnosis was not present at time of inpatient admission. | NO |
U | Documentation insufficient to determine if the condition was present at the time of inpatient admission. | NO |
W | Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission. | YES |
1 | Unreported/Not used - Exempt from POA reporting. | NO |
Convert Q43.6 to ICD-9 Code
The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code Q43.6 its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.
- 751.5 - Intestinal anomaly NEC (Approximate Flag)
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)
[Learn 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)
[Learn 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)
[Learn More]
Code History
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)