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ICD-10-CM 2027 diagnosis code

Q38.5Congenital malformations of palate, not elsewhere classified

✓ Billable / specificPOA exempt

Q38.5 is a valid, billable ICD-10-CM code for congenital malformations of palate, not elsewhere classified. It can be reported on claims for dates of service from October 1, 2026 – September 30, 2027.

Code unchanged since ICD-10-CM took effect on October 1, 2015. Source: official FY2027 ICD-10-CM release from CDC/NCHS and CMS. Page updated September 29, 2026. About our data

About Q38.5

Q38.5 is the ICD-10-CM diagnosis code for congenital malformations of palate, not elsewhere classified. It belongs to category Q38 (other congenital malformations of tongue, mouth and pharynx), block Q38-Q45 (other congenital malformations of the digestive system) and chapter 17 (congenital malformations, deformations, chromosomal abnormalities, and genetic disorders). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

Within Q38 (other congenital malformations of tongue, mouth and pharynx), Q38.5 is specifically for congenital malformations of palate, not elsewhere classified. Related codes cover congenital malformations of lips, not elsewhere classified (Q38.0), Ankyloglossia (Q38.1), Macroglossia (Q38.2), other congenital malformations of tongue (Q38.3), congenital malformations of salivary glands and ducts (Q38.4), other congenital malformations of mouth (Q38.6), congenital pharyngeal pouch (Q38.7) and other congenital malformations of pharynx (Q38.8).

Don't report Q38.5 together with the conditions in its Excludes1 note: cleft palate (Q35.-) and cleft palate with cleft lip (Q37.-).

It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.

In MS-DRG v44.0, it is part of the grouping logic for DRG 393 (Other Digestive System Diagnoses with MCC, relative weight 1.5881), DRG 394 (Other Digestive System Diagnoses with CC, relative weight 0.9228) and DRG 395 (Other Digestive System Diagnoses without CC/MCC, relative weight 0.6382), in MDC 06 (Diseases and Disorders of the Digestive System), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.

It is exempt from present-on-admission (POA) reporting, so no POA indicator is required.

It has been part of ICD-10-CM since the code set took effect on October 1, 2015 and hasn't changed since.

Before ICD-10, this condition was coded in ICD-9-CM as 750.9 (unspecified anomaly of upper alimentary tract).

Coding notes

Applicable toConditions and synonyms classified to this code
  • Congenital absence of uvula
  • Congenital malformation of palate NOS
  • Congenital high arched palate
Excludes1Not coded here — never report together with this code
  • cleft palate (Q35.-)
  • cleft palate with cleft lip (Q37.-)

Notes that apply from higher levels

Instructions written at a parent level also apply to Q38.5.

› From Q38 Other congenital malformations of tongue, mouth and pharynx
Excludes1
  • dentofacial anomalies (M26.-)
  • macrostomia (Q18.4)
  • microstomia (Q18.5)

Broader instructions also apply from Chapter 17: Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders.

Alphabetic index entries

12 entries

Terms in the official ICD-10-CM index that lead to Q38.5.

MS-DRG v44.0 grouping

All DRGs →

Inpatient MS-DRGs this diagnosis can group to, as the principal or a secondary diagnosis, depending on the rest of the claim.

ICD-9-CM equivalent

Converter →
  • 750.9Unspecified anomaly of upper alimentary tractapproximate

From the CMS 2018 General Equivalence Mappings (GEMs), the final GEMs release.

Code history

  1. 2016
  2. 2017
  3. 2018
  4. 2019
  5. 2020
  6. 2021
  7. 2022
  8. 2023
  9. 2024
  10. 2025
  11. 2026
  12. 2027
  • FY2016 (effective 10/1/2015): Added (first year of ICD-10-CM)
  • No changes since FY2016.

Common questions about Q38.5

Is Q38.5 billable?

Yes. Q38.5 is a billable/specific ICD-10-CM code valid for FY2027 (October 1, 2026 – September 30, 2027).

Can Q38.5 be used as a principal diagnosis?

Yes. The Medicare Code Editor doesn't restrict Q38.5 as a principal diagnosis.

Is Q38.5 a CC or MCC?

No. Q38.5 is neither a CC nor an MCC under MS-DRG v44.0.

What DRG does Q38.5 group to?

Q38.5 is used in the MS-DRG v44.0 logic for MS-DRG 393 (Other Digestive System Diagnoses with MCC), MS-DRG 394 (Other Digestive System Diagnoses with CC) and MS-DRG 395 (Other Digestive System Diagnoses without CC/MCC). Which one applies depends on whether it is the principal diagnosis and on the rest of the claim.

What is the ICD-9 code for Q38.5?

The CMS General Equivalence Mappings map Q38.5 to ICD-9-CM 750.9.