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ICD-10-CM Code Q43.6
Congenital fistula of rectum and anus

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

Q43.6 is a billable ICD code used to specify a diagnosis of congenital fistula of rectum and anus. 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 Q43.6 Info for medical coders on how to properly use this ICD-10 code

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."
Congenital fistula of anus with absence, atresia and stenosis - instead, use code Q42.2
Congenital fistula of rectum with absence, atresia and stenosis - instead, use code Q42.0
Congenital rectovaginal fistula - instead, use code Q52.2
Congenital urethrorectal fistula - instead, use code Q64.73
Pilonidal fistula or sinus - instead, use code L05.-

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.

Related Concepts SNOMET-CT

  • Congenital rectocloacal fistula (disorder)

ICD-10-CM Alphabetical Index References for 'Q43.6 - Congenital fistula of rectum and anus'

The ICD-10-CM Alphabetical Index links the below-listed medical terms to the ICD code Q43.6. Click on any term below to browse the alphabetical index.

Equivalent ICD-9 Code GENERAL EQUIVALENCE MAPPINGS (GEM)

Other anomalies of intestine (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 Q43.6 and a single ICD9 code, 751.5 is an approximate match for comparison and conversion purposes.


Parent Code: Q43 - Other congenital malformations of intestine

** This Document Provided By ICD.Codes **
Source: http://icd.codes/icd10cm/Q436