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Q38.6 ICD-10-CM Code: Other congenital malformations of mouth

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 3 Excludes1

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 011 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC (MDC PRE)
  • MS-DRG 012 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC (MDC PRE)
  • MS-DRG 013 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC (MDC PRE)
  • MS-DRG 157 — DENTAL AND ORAL DISEASES WITH MCC (MDC 03)
  • MS-DRG 158 — DENTAL AND ORAL DISEASES WITH CC (MDC 03)
  • MS-DRG 159 — DENTAL AND ORAL DISEASES WITHOUT CC/MCC (MDC 03)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for Q38.6 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on Q38.6 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Congenital malformation of mouth NOS

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from Q38

Coder workflow for Q38.6

MedCoder structured workflow — derived from this code’s own official record

Before you code Q38.6

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on Q38.6; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    ReviewQ38.1, Q38.2, Q38.4, Q38.7

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with Q38.6. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in Q38.6’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewM26, Q18.4, Q18.5

Consider Q38.6. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting Q38.6(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with Q38.6: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareM26, Q18.4, Q18.5

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition Q38.6 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewM26, Q18.4, Q18.5

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse Q38.6 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of Q38.6 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • M26— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of dentofacial anomalies moves the case to M26; the two are not reported together unless documented as unrelated.

    Full comparison: Q38.6 vs M26 →

  • Q18.4— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of macrostomia moves the case to Q18.4; the two are not reported together unless documented as unrelated.

    Full comparison: Q38.6 vs Q18.4 →

  • Q18.5— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of microstomia moves the case to Q18.5; the two are not reported together unless documented as unrelated.

    Full comparison: Q38.6 vs Q18.5 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Other congenital malformations of mouth is a billable ICD-10-CM diagnosis code (Q38.6).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (22)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 6 MS-DRGs: DRG 011 (MDC PRE), DRG 012 (MDC PRE), DRG 013 (MDC PRE), DRG 157 (MDC 03), DRG 158 (MDC 03), DRG 159 (MDC 03).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MAL002 — Digestive congenital anomalies (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Digestive congenital anomalies).

Q38.0 — Congenital malformations of lips, not elsewhere classified, Q38.1 — Ankyloglossia, Q38.2 — Macroglossia, Q38.3 — Other congenital malformations of tongue, Q38.4 — Congenital malformations of salivary glands and ducts, Q38.5 — Congenital malformations of palate, not elsewhere classified, Q38.7 — Congenital pharyngeal pouch, Q38.8 — Other congenital malformations of pharynx, Q39.0 — Atresia of esophagus without fistula, Q39.1 — Atresia of esophagus with tracheo-esophageal fistula, Q39.2 — Congenital tracheo-esophageal fistula without atresia, Q39.3 — Congenital stenosis and stricture of esophagus, Q39.4 — Esophageal web, Q39.5 — Congenital dilatation of esophagus, Q39.6 — Congenital diverticulum of esophagus, Q39.8 — Other congenital malformations of esophagus, Q39.9 — Congenital malformation of esophagus, unspecified, Q40.0 — Congenital hypertrophic pyloric stenosis, Q40.1 — Congenital hiatus hernia, Q40.2 — Other specified congenital malformations of stomach, +41 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Absence”, “Deformity”, “Malformation”, …; these codes share that main term but sit in a different category of the Tabular List.

Q32.1 — Other congenital malformations of trachea (trachea), Q32.4 — Other congenital malformations of bronchus (bronchus), Q33.0 — Congenital cystic lung (lung, congenital), Q33.3 — Agenesis of lung (lung), Q33.5 — Ectopic tissue in lung (tissue in lung), Q33.9 — Congenital malformation of lung, unspecified (lung), Q34.0 — Anomaly of pleura (pleural), Q34.1 — Congenital cyst of mediastinum (mediastinum, congenital), Q34.8 — Other specified congenital malformations of respiratory system (respiratory system, specified NEC), Q34.9 — Congenital malformation of respiratory system, unspecified (respiratory system), Q39.8 — Other congenital malformations of esophagus (esophagus), Q39.9 — Congenital malformation of esophagus, unspecified (esophagus), Q40.2 — Other specified congenital malformations of stomach (stomach, congenital), Q40.3 — Congenital malformation of stomach, unspecified (pylorus), Q40.8 — Other specified congenital malformations of upper alimentary tract (alimentary tract, upper), Q40.9 — Congenital malformation of upper alimentary tract, unspecified (alimentary tract, upper), Q41.0 — Congenital absence, atresia and stenosis of duodenum (duodenum, congenital), Q41.1 — Congenital absence, atresia and stenosis of jejunum (jejunum, congenital), Q41.2 — Congenital absence, atresia and stenosis of ileum (ileum, congenital), Q41.8 — Congenital absence, atresia and stenosis of other specified parts of small intestine (intestine, congenital, specified NEC), +802 more

Contextual Map

Every relationship of Q38.6 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • Pre-MDC[MDC crossing]: “Pre-MDC — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 175 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027
  • MDC 03 — Diseases and Disorders of the Ear, Nose, Mouth and Throat[MDC crossing]: “Diseases and Disorders of the Ear, Nose, Mouth and Throat — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,151 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries (22)

  • Aberrant (congenital), sebaceous glands, mucous membrane, mouth, congenital[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Absence (of) (organ or part) (complete or partial), lip[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Acheilia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Anomaly, anomalous (congenital) (unspecified type), gum[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Anomaly, anomalous (congenital) (unspecified type), mouth[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Aplasia, alveolar process (acquired), congenital[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Cyst (colloid) (mucous) (simple) (retention), congenital NEC, sublingual[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Cyst (colloid) (mucous) (simple) (retention), congenital NEC, submaxillary gland[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • and 14 more

Nearest codes (9)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "Q38.6 — Other congenital malformations of mouth." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/q38.6-other-congenital-malformations-of-mouth

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other congenital malformations of mouth

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to Q38.6 in its code family, with their registry titles.

View all codes in the Q38 family