ICDcodes.org
FY2027

Q38.5 — Congenital malformations of palate, not elsewhere classified

BillableUnspecified

Is Q38.5 billable?

Yes, but Q38.5 is an unspecified code. Q38.5 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, Q38.5 is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting Q38.5 — the more specific alternatives are listed below.

Q38.5 at a glance

CodeQ38.5
DescriptionCongenital malformations of palate, not elsewhere classified
BillableYes
Code setICD-10-CM FY2027
Valid for encountersOctober 1, 2026 – September 30, 2027

Which MS-DRGs does Q38.5 group to?

Q38.5 sits in MDC 06 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.

  • 393Other Digestive System Diagnoses with MCCmedical
  • 394Other Digestive System Diagnoses with CCmedical
  • 395Other Digestive System Diagnoses without CC/MCCmedical

How is Q38.5 listed in the Alphabetic Index?

These are the routes through the Alphabetic Index that lead to Q38.5. They show the wording a clinician may have documented, which often differs from the Tabular description.

  • Absence › uvula, congenital (of) (organ or part) (complete or partial)
  • Agenesis › uvula
  • Anomaly, anomalous › palateNEC (congenital) (unspecified type)
  • Anomaly, anomalous › uvula (congenital) (unspecified type)
  • Deformity › palate
  • Deformity › uvula
  • Flaccid › palate, congenital
  • High › palate, congenital
  • Malformation › palate (congenital)
  • Short, shortening, shortness › palate, congenital
  • Short, shortening, shortness › uvula, congenital
  • High › arch › palate, congenital

Excludes1 — never code together

The conditions below can never be reported together with Q38.5 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.

  • cleft palate (Q35.-)
  • cleft palate with cleft lip (Q37.-)

Inclusion terms

Alternative wording in documentation that is classified to Q38.5.

  • Congenital absence of uvula
  • Congenital malformation of palate NOS
  • Congenital high arched palate

Excludes1 — never code together — inherited from Q38

The conditions below can never be reported together with Q38.5 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.

Excludes2 — not included here — inherited from Chapter 17

The conditions below are not part of Q38.5, but a patient may have both at the same time. When documentation supports it, Q38.5 and the excluded code may both be reported.

  • inborn errors of metabolism (E70-E88)

How long has Q38.5 existed?

Q38.5 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.

Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.

Which codes are confused with Q38.5?

ICD-10-CM declares these codes mutually exclusive with Q38.5 — exactly one of each pair can be correct for a given encounter.

Which conditions are coded to Q38.5?

What other codes are in the Q38 family? (8)