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Code
Description

ICD-10-CM Code Q38.5
Congenital malformations of palate, not elsewhere classified

BILLABLE
Billable Code
Billable codes are sufficient justification for admission to an acute care hospital when used a principal diagnosis.
POA Exempt
POA Exempt Code
The Center for Medicare & Medicaid Services (CMS) requires medical coders to indicate whether or not a condition was present at the time of admission, in order to properly assign MS-DRG codes. This "Present On Admission" (POA) indicator is recorded on CMS form 4010A.
| ICD-10 from 2011 - 2016

Q38.5 is a billable ICD code used to specify a diagnosis of congenital malformations of palate, not elsewhere classified. A 'billable code' is detailed enough to be used to specify a medical diagnosis.

POA Indicators on CMS form 4010A are as follows:

IndicatorMeaningCMS Will Pay CC/MCC DRG Costs
YDiagnosis was present at time of inpatient admissionYes
NDiagnosis was not present at time of inpatient admissionNo
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.No
WClinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission.Yes
1Exempt from POA reportingNo


Coding Notes for Q38.5 Info for medical coders on how to properly use this ICD-10 code

Inclusion Terms:
Inclusion Terms
Inclusion Terms are a list of concepts for which a specific code is used. The list of Inclusion Terms is useful for determining the correct code in some cases, but the list is not necessarily exhaustive.
Congenital absence of uvula
Congenital malformation of palate NOS
Congenital high arched palate
Code Type-1 Excludes:
Type-1 Excludes
Type-1 Excludes mean the conditions excluded are mutually exclusive and should never be coded together. Excludes 1 means "do not code here."
Cleft palate - instead, use code Q35.-
Cleft palate with cleft lip - instead, use code Q37.-

MS-DRG Mapping

  • DRG Group #393-395 - Other digestive system diagnoses with MCC.
  • DRG Group #393-395 - Other digestive system diagnoses with CC.
  • DRG Group #393-395 - Other digestive system diagnoses without CC or MCC.

ICD-10-CM Alphabetical Index References for 'Q38.5 - Congenital malformations of palate, not elsewhere classified'

The ICD-10-CM Alphabetical Index links the below-listed medical terms to the ICD code Q38.5. Click on any term below to browse the alphabetical index.

Equivalent ICD-9 Code GENERAL EQUIVALENCE MAPPINGS (GEM)

Unspecified anomaly of upper alimentary tract (approximate match)

This is the official approximate match mapping between ICD9 and ICD10, as provided by the General Equivalency mapping crosswalk. This means that while there is no exact mapping between this ICD10 code Q38.5 and a single ICD9 code, 750.9 is an approximate match for comparison and conversion purposes.


Parent Code: Q38 - Other congenital malformations of tongue, mouth and pharynx

** This Document Provided By ICD.Codes **
Source: http://icd.codes/icd10cm/Q385