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v1.0.0
ICD-10 Guide
ICD-10 CodesQ43.2

Q43.2

Billable

Other congenital functional disorders of colon

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

Code Description

ICD-10 Q43.2 is a billable code used to indicate a diagnosis of other congenital functional disorders of colon.

Key Diagnostic Point:

Congenital functional disorders of the colon encompass a range of malformations that can significantly impact gastrointestinal function in pediatric patients. This includes conditions such as Hirschsprung disease, where there is an absence of ganglion cells in the distal colon, leading to severe constipation or intestinal obstruction. Esophageal atresia, while primarily affecting the esophagus, can also lead to complications in the digestive system, including issues with the colon due to associated anomalies. Imperforate anus is another critical condition where the anal opening is absent or blocked, necessitating surgical intervention. Gastroschisis, characterized by the protrusion of the intestines through a defect in the abdominal wall, can lead to malabsorption and functional disorders of the colon. These conditions often require multidisciplinary management, including surgical correction and ongoing gastrointestinal support, making accurate coding essential for proper treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of conditions
  • Need for precise documentation of associated anomalies
  • Potential for multiple surgical interventions and follow-up care
  • Differentiation between similar congenital conditions

Audit Risk Factors

  • Inadequate documentation of associated congenital anomalies
  • Failure to capture all relevant procedures performed
  • Misclassification of the severity of the condition
  • Inconsistent coding across different healthcare settings

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes on the patient's growth, development, and any surgical interventions performed.

Common Clinical Scenarios

Management of a newborn with Hirschsprung disease requiring colostomy, or a child with gastroschisis undergoing multiple surgeries.

Billing Considerations

Pediatric coders must be aware of growth milestones and developmental assessments that may impact the coding of congenital conditions.

Genetics

Documentation Requirements

Genetic testing results, family history, and any syndromic associations with congenital conditions.

Common Clinical Scenarios

Genetic counseling for families with a history of congenital malformations or chromosomal abnormalities.

Billing Considerations

Genetic coders should ensure that chromosomal abnormalities are accurately linked to the congenital conditions being coded.

Coding Guidelines

Inclusion Criteria

Use Q43.2 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 and treatment

Exclusion Criteria

Do NOT use Q43.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

44180CPT Code

Colectomy, partial, with anastomosis

Clinical Scenario

Used in cases of Hirschsprung disease where resection of the affected bowel is necessary.

Documentation Requirements

Operative reports detailing the extent of resection and anastomosis.

Specialty Considerations

Pediatric surgeons must provide clear documentation of the surgical approach and any complications.

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 ability to capture the complexity of these disorders and their management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the ability to capture the complexity of these disorders and their management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the ability to capture the complexity of these disorders and their management.

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 documentation is necessary for coding Q43.2?

Comprehensive documentation should include the patient's clinical history, details of any surgical interventions, and any associated congenital anomalies. It is crucial to ensure that all relevant information is captured to support the coding of the condition accurately.