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    OpenPayerBilling CodesOther congenital malformations of the digestive systemICD-10-CM q38-other-congenital-malformations-tongue-mouth-pharynx
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    ICD-10-CM Code For Other Congenital Malformations Of Tongue Mouth And Pharynx: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group Q38 includes congenital malformations of the tongue, mouth, and pharynx such as ankyloglossia, congenital oral cysts, and other specified structural anomalies that affect oral and pharyngeal anatomy. These ICD-10-CM diagnosis codes are used to document clinical encounters where congenital defects of the oropharyngeal region are assessed, treated, or monitored — capturing anatomic involvement and potential functional consequences like feeding or speech impairment. Accurate coding within the ICD-10-CM Q38 group supports proper claim adjudication, complete clinical documentation, and appropriate reimbursement.

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    ICD-10-CM Q38: Other Congenital Malformations Of Tongue, Mouth And Pharynx Overview

    The ICD-10-CM Q38 diagnosis group includes congenital malformations affecting the tongue, oral cavity, and pharynx such as ankyloglossia (tongue-tie), congenital cysts, and other structural anomalies. These conditions target the oropharyngeal and oral structures and may impact feeding, speech, and airway function. Accurate coding is important for representing clinical complexity and supporting appropriate reimbursement for services related to diagnosis, management, and surgical correction.

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    When to Use

    Use a code from this group when documenting encounters for evaluation, management, or surgical treatment of congenital malformations involving the tongue, oral cavity, or pharynx. Select the most specific code available to reflect the exact anatomic site and nature of the congenital anomaly.

    ICD-10-CM Codes

    9 rows

    ICD-10-CM CodeDescription
    Q38.0Congenital malformations of lips, not elsewhere classified
    Q38.1Ankyloglossia
    Q38.2Macroglossia
    Q38.3Other congenital malformations of tongue
    Q38.4Congenital malformations of salivary glands and ducts
    Q38.5Congenital malformations of palate, not elsewhere classified
    Q38.6Other congenital malformations of mouth
    Q38.7Congenital pharyngeal pouch
    Q38.8Other congenital malformations of pharynx

    DRG Codes

    13 rows

    DRG CodeDescription
    011Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC
    012Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC
    013Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC
    154Other Ear, Nose, Mouth and Throat Diagnoses with MCC
    155Other Ear, Nose, Mouth and Throat Diagnoses with CC
    156Other Ear, Nose, Mouth and Throat Diagnoses without CC/MCC
    157Dental and Oral Diseases with MCC
    158Dental and Oral Diseases with CC
    159Dental and Oral Diseases without CC/MCC
    393Other Digestive System Diagnoses with MCC
    394Other Digestive System Diagnoses with CC
    395Other Digestive System Diagnoses without CC/MCC
    795Normal Newborn

    Typical Clinical Scenarios

    • A newborn with an obvious midline oral mass and feeding difficulty is evaluated in the neonatal unit; physical exam shows a small extra tissue projection on the tongue consistent with a lingual polyp or hamartoma causing poor latch and airway concern, prompting surgical consultation and planned excision. A congenital malformation of the tongue is recorded as the primary diagnosis for operative planning and newborn care. Typical codes: Q38.0, Q38.8.
    • An adolescent presents to otolaryngology for chronic nasal speech and recurrent otitis media; exam and nasopharyngoscopy reveal a submucous cleft palate with a high-arched, bifid soft palate contributing to velopharyngeal insufficiency and Eustachian tube dysfunction. The congenital anomaly of the soft palate is documented to guide speech therapy and possible surgical repair. Typical codes: Q38.2, Q38.3.
    • An adult with a history of repaired cleft lip in childhood is seen preoperatively for orthognathic surgery planning and has persistent congenital malformation of the oral cavity (including alveolar ridge defect and residual clefting) complicating dental occlusion and prosthetic rehabilitation; the congenital oral malformation is coded as a comorbidity affecting surgical planning and dental management. Typical codes: Q38.4, Q38.5.

    Related Codes

    Q39-CONGENITAL-MALFORMATIONS-OF-ESOPHAGUS

    ICD-10-CM Code For Congenital Malformations Of Esophagus: Group Overview

    Q40-OTHER-CONGENITAL-MALFORMATIONS-UPPER-ALIMENTARY-TRACT

    ICD-10-CM Code For Other Congenital Malformations Of Upper Alimentary Tract: Group Overview

    Q41-CONGENITAL-ABSENCE-ATRESIA-STENOSIS-SMALL-INTESTINE

    ICD-10-CM Code For Congenital Absence, Atresia And Stenosis Of Small Intestine: Group Overview

    Q42-CONGENITAL-LARGE-INTESTINE-MALFORMATIONS

    ICD-10-CM Code For Congenital Absence, Atresia And Stenosis Of Large Intestine: Group Overview

    Q43-OTHER-CONGENITAL-MALFORMATIONS-OF-INTESTINE

    ICD-10-CM Code For Other Congenital Malformations Of Intestine: Group Overview

    Q44-CONGENITAL-MALFORMATIONS-OF-GALLBLADDER

    ICD-10-CM Code For Congenital Malformations Of Gallbladder, Bile Ducts And Liver: Group Overview

    Q45-OTHER-CONGENITAL-MALFORMATIONS-DIGESTIVE

    ICD-10-CM Code For Other Congenital Malformations Of Digestive System: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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