Q42.0 vs Q43.6
Q42.0 (Congenital absence, atresia and stenosis of rectum with fistula) compared with Q43.6 (Congenital fistula of rectum and anus), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
No — do not report together. Q43.6 carries an Excludes1 note covering Q42.0: “congenital fistula of rectum with absence, atresia and stenosis (Q42.0)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Side by side
| Q42.0Congenital absence, atresia and stenosis of rectum with fistula | Q43.6Congenital fistula of rectum and anus | |
|---|---|---|
| Billing status | Billable | Billable |
| Classification | Q00-Q99 — Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99) | Q00-Q99 — Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99) |
| Definition | Congenital absence, atresia and stenosis of rectum with fistula is a billable ICD-10-CM diagnosis code (Q42.0). | Congenital fistula of rectum and anus is a billable ICD-10-CM diagnosis code (Q43.6). |
| Includes | congenital obstruction, occlusion and stricture of large intestine | — |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources