ICD-10 Q38.7
Billable / SpecificCongenital pharyngeal pouch
About ICD-10-CM Q38.7
ICD-10-CM code Q38.7 represents Congenital pharyngeal pouch. This is a billable/specific code in the Congenital Malformations chapter (block Q38). The 2026 edition of ICD-10-CM Q38.7 became effective on October 1, 2025.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under Q38.7. Per CMS ICD-10-CM Tabular 2026.
- Congenital diverticulum of pharynx
Type 1 Excludes
Pure excludes, these codes can never be coded together with Q38.7. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- pharyngeal pouch syndrome (D82.1)
Medicare LCD Coverage for Q38.7
Local Coverage Determinations (LCDs) from CMS MACs that list Q38.7 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing Q38.7.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but Q38.7 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with Q38.7
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert Q38.7 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| Q38.7 | 75027 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To Q38.7
Other codes in section Q38-Q45 (Other congenital malformations of the digestive system).
ICD-10 Q38.7, Billing FAQ
Is ICD-10 code Q38.7 billable? +
Yes, Q38.7 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to Q38.7? +
ICD-10 Q38.7 includes: Congenital diverticulum of pharynx.
What codes are Type 1 Excludes for Q38.7? +
Type 1 Excludes (never code together with Q38.7): pharyngeal pouch syndrome (D82.1)
What ICD-9 codes does Q38.7 map to? +
Per CMS GEMs, Q38.7 maps to ICD-9 codes: 75027. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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