A50.5- vs Q67.4
A50.5 and Q67.4 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.
Other late congenital syphilis, symptomatic
- Chapter 1
- Certain infectious and parasitic diseases
- Section
- A50-A64
- Any congenital syphilitic condition specified as late or manifest two years or more after birth.
Other congenital deformities of skull, face and jaw
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q65-Q79
- Congenital depressions in skull
- Congenital hemifacial atrophy or hypertrophy
- Deviation of nasal septum, congenital
- Squashed or bent nose, congenital
- Atrophy, atrophic › hemifacial
- Depression › skull
- Flattening › nose (congenital)
- Friedreich's › facial hemihypertrophy
- Hypertrophy, hypertrophic › hemifacial
These two codes sit in different chapters of the Tabular List, which is usually the clearest signal that they describe different underlying processes rather than different degrees of the same one.
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027