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ICD-10 Guide
ICD-10 CodesQ38.7

Q38.7

Billable

Congenital pharyngeal pouch

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 Q38.7 is a billable code used to indicate a diagnosis of congenital pharyngeal pouch.

Key Diagnostic Point:

Congenital pharyngeal pouch, also known as a pharyngeal diverticulum, is a rare congenital malformation characterized by the formation of a pouch in the pharyngeal wall. This condition typically arises from an abnormality in the development of the pharynx during embryogenesis. The pouch can lead to swallowing difficulties, aspiration, and respiratory complications due to the accumulation of food or secretions. In pediatric patients, it may present with symptoms such as chronic cough, recurrent respiratory infections, and failure to thrive. Diagnosis is often made through imaging studies such as a barium swallow or endoscopy. Treatment usually involves surgical intervention to excise the pouch and prevent complications. The condition may be associated with other congenital anomalies, particularly those affecting the respiratory system, such as choanal atresia, tracheoesophageal fistula, and lung hypoplasia, which can complicate the clinical picture and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms among patients
  • Potential association with other congenital anomalies
  • Need for detailed imaging and surgical documentation
  • Differentiation from other pharyngeal conditions

Audit Risk Factors

  • Inadequate documentation of associated congenital anomalies
  • Failure to document surgical interventions
  • Misclassification of symptoms related to respiratory complications
  • Lack of clarity in the clinical rationale for coding

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes on symptoms, diagnostic imaging, and treatment plans are essential for accurate coding.

Common Clinical Scenarios

Pediatric patients presenting with feeding difficulties, recurrent respiratory infections, or failure to thrive due to congenital pharyngeal pouch.

Billing Considerations

Consideration of the patient's age and developmental milestones is crucial in pediatric coding.

Genetics

Documentation Requirements

Genetic testing results and family history documentation are important for understanding potential chromosomal abnormalities.

Common Clinical Scenarios

Cases where congenital pharyngeal pouch is part of a syndrome with known genetic implications.

Billing Considerations

Awareness of syndromic associations and the need for genetic counseling in affected families.

Coding Guidelines

Inclusion Criteria

Use Q38.7 When
  • Follow the official ICD
  • CM coding guidelines for congenital conditions, ensuring accurate documentation of the condition's clinical significance and any associated anomalies

Exclusion Criteria

Do NOT use Q38.7 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

43200CPT Code

Esophagogastroduodenoscopy

Clinical Scenario

Used to visualize the pharyngeal pouch during diagnosis.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Pediatric gastroenterology may be involved in the procedure.

42800CPT Code

Surgical excision of pharyngeal pouch

Clinical Scenario

Performed to treat the congenital pharyngeal pouch.

Documentation Requirements

Detailed operative notes and post-operative care plans are essential.

Specialty Considerations

Surgical documentation must include indications and outcomes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common symptoms of congenital pharyngeal pouch?

Common symptoms include difficulty swallowing, recurrent respiratory infections, aspiration, and failure to thrive in infants. These symptoms arise due to the accumulation of food or secretions in the pouch, leading to complications.