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v1.0.0
ICD-10 Guide
ICD-10 CodesQ38.8

Q38.8

Billable

Other congenital malformations of pharynx

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

Code Description

ICD-10 Q38.8 is a billable code used to indicate a diagnosis of other congenital malformations of pharynx.

Key Diagnostic Point:

Congenital malformations of the pharynx can significantly impact respiratory function and swallowing. This category includes various structural anomalies that may not fit into more specific classifications. Conditions such as choanal atresia, where the nasal passage is blocked, and tracheoesophageal fistula, which connects the trachea and esophagus abnormally, are critical examples. These malformations can lead to severe respiratory distress, feeding difficulties, and increased risk of aspiration. Lung hypoplasia, characterized by underdeveloped lungs, often accompanies these conditions, complicating the clinical picture. Diagnosis typically involves imaging studies and clinical evaluation, with management strategies ranging from surgical intervention to supportive care. Accurate coding is essential for appropriate treatment planning and resource allocation in pediatric care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of conditions
  • Need for detailed clinical documentation to support coding
  • Potential for multiple coexisting congenital anomalies
  • Differentiation from similar conditions requiring precise coding

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Misclassification of congenital anomalies
  • Failure to capture coexisting conditions
  • Inconsistent use of terminology in medical records

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed growth and development assessments, feeding history, and respiratory evaluations are essential.

Common Clinical Scenarios

Infants presenting with respiratory distress, failure to thrive, or feeding difficulties due to congenital anomalies.

Billing Considerations

Consideration of age-specific developmental milestones and the impact of congenital conditions on overall health.

Genetics

Documentation Requirements

Genetic testing results, family history of congenital conditions, and chromosomal analysis documentation are crucial.

Common Clinical Scenarios

Cases involving syndromic presentations where genetic counseling is necessary for family planning.

Billing Considerations

Understanding the genetic basis of congenital anomalies and their implications for future pregnancies.

Coding Guidelines

Inclusion Criteria

Use Q38.8 When
  • Follow the official ICD
  • CM coding guidelines for congenital conditions, ensuring that all relevant clinical information is documented and that codes accurately reflect the patient's condition

Exclusion Criteria

Do NOT use Q38.8 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

31500CPT Code

Intubation, endotracheal, emergency

Clinical Scenario

Used in cases of respiratory distress due to pharyngeal malformations.

Documentation Requirements

Document the indication for intubation and any associated congenital conditions.

Specialty Considerations

Pediatric anesthesiology may require additional documentation for airway management.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving the accuracy of patient records and facilitating better healthcare outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving the accuracy of patient records and facilitating better healthcare outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving the accuracy of patient records and facilitating better healthcare outcomes.

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 congenital malformations of the pharynx?

Common congenital malformations include choanal atresia, tracheoesophageal fistula, and other structural anomalies that can affect breathing and swallowing. Accurate coding is essential for appropriate management and treatment.