Q42.0 — Congenital absence, atresia and stenosis of rectum with fistula
Is Q42.0 billable?
Yes — Q42.0 is billable for FY2027. Q42.0 is a valid, billable ICD-10-CM code at the highest level of specificity in its branch. Q42.0 may be submitted for encounters from October 1, 2026 through September 30, 2027.
Q42.0 at a glance
| Code | Q42.0 |
|---|---|
| Description | Congenital absence, atresia and stenosis of rectum with fistula |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
Which MS-DRGs does Q42.0 group to?
Q42.0 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
As a secondary diagnosis, Q42.0 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is Q42.0 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to Q42.0. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Absence › rectum › with fistula (of) (organ or part) (complete or partial)
- Agenesis › rectum › with fistula
- Atresia, atretic › rectum › with fistula
- Hypoplasia, hypoplastic › rectum › with fistula
- Imperforate › rectum › with fistula (congenital)
- Impervious › rectum › with fistula (congenital)
- Fistula › rectum › congenital › with absence, atresia and stenosis (cutaneous)
- Stricture › rectum › congenital › with fistula
Excludes2 — not included here — inherited from Chapter 17
The conditions below are not part of Q42.0, but a patient may have both at the same time. When documentation supports it, Q42.0 and the excluded code may both be reported.
- inborn errors of metabolism (E70-E88)
How long has Q42.0 existed?
Q42.0 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 Q42.0?
ICD-10-CM declares these codes mutually exclusive with Q42.0 — exactly one of each pair can be correct for a given encounter.
What other codes are in the Q42 family? (5)
- Q42.1Congenital absence, atresia and stenosis of rectum without fistula
- Q42.2Congenital absence, atresia and stenosis of anus with fistula
- Q42.3Congenital absence, atresia and stenosis of anus without fistula
- Q42.8Congenital absence, atresia and stenosis of other parts of large intestine
- Q42.9Congenital absence, atresia and stenosis of large intestine, part unspecified