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ICD-10 Guide
ICD-10 CodesQ43.1

Q43.1

Billable

Hirschsprung's disease

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

Code Description

ICD-10 Q43.1 is a billable code used to indicate a diagnosis of hirschsprung's disease.

Key Diagnostic Point:

Hirschsprung's disease, also known as congenital aganglionic megacolon, is a congenital condition characterized by the absence of ganglion cells in a segment of the colon, leading to a lack of peristalsis and subsequent obstruction. This condition typically presents in neonates and infants, often manifesting as failure to pass meconium within the first 48 hours of life, abdominal distension, and vomiting. The affected segment of the bowel is unable to relax, causing a functional obstruction that can lead to severe constipation and enterocolitis if not treated. Diagnosis is confirmed through rectal biopsy, which reveals the absence of ganglion cells. Surgical intervention, usually involving resection of the aganglionic segment, is the primary treatment. Early diagnosis and management are crucial to prevent complications such as bowel perforation and sepsis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other congenital bowel obstructions
  • Need for precise documentation of the extent of the aganglionic segment
  • Potential for associated anomalies requiring additional coding
  • Variability in presentation and severity among patients

Audit Risk Factors

  • Inadequate documentation of the diagnosis and treatment plan
  • Failure to document associated congenital anomalies
  • Incorrect coding of the surgical procedure performed
  • Lack of follow-up documentation post-surgery

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes on symptoms, diagnostic tests, and treatment plans are essential. Documentation should include the age of onset, clinical presentation, and any associated conditions.

Common Clinical Scenarios

Common scenarios include a newborn presenting with failure to pass meconium, abdominal distension, and subsequent surgical intervention.

Billing Considerations

Pediatric coders must be aware of the developmental implications of Hirschsprung's disease and the need for long-term follow-up.

Genetics

Documentation Requirements

Genetic counseling notes should document any family history of congenital conditions, genetic testing results, and implications for future pregnancies.

Common Clinical Scenarios

Scenarios may include genetic counseling for families with a history of Hirschsprung's disease or associated syndromes.

Billing Considerations

Genetic coders should consider the potential for chromosomal abnormalities that may co-occur with Hirschsprung's disease.

Coding Guidelines

Inclusion Criteria

Use Q43.1 When
  • Follow the official ICD
  • CM coding guidelines for congenital malformations, ensuring accurate documentation of the diagnosis, associated conditions, and any surgical procedures performed

Exclusion Criteria

Do NOT use Q43.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

44160CPT Code

Resection of rectum and colon

Clinical Scenario

Used in the surgical treatment of Hirschsprung's disease.

Documentation Requirements

Operative report detailing the procedure, extent of resection, and any complications.

Specialty Considerations

Pediatric surgeons must document the specific technique used and any intraoperative findings.

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 diagnoses and treatment tracking for Hirschsprung's disease.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the accuracy of diagnoses and treatment tracking for Hirschsprung's disease.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the accuracy of diagnoses and treatment tracking for Hirschsprung's disease.

Resources

Clinical References

  • •
    Hirschsprung's Disease Foundation

Coding & Billing References

  • •
    Hirschsprung's Disease Foundation

Frequently Asked Questions

What are the common symptoms of Hirschsprung's disease?

Common symptoms include failure to pass meconium within the first 48 hours of life, abdominal distension, vomiting, and severe constipation. Diagnosis is confirmed through rectal biopsy.