Excludes1 pair
C41.0 vs C69.6-
C41.0 and C69.6 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.
The official note, declared on C69.6
malignant neoplasm of orbital bone (C41.0)
C41.0
Malignant neoplasm of bones of skull and face
Billable
- Chapter 2
- Neoplasms
- Section
- C40-C41
Use when the record says
- Malignant neoplasm of maxilla (superior)
- Malignant neoplasm of orbital bone
Indexed under
- Odontosarcoma, ameloblastic › upper jaw (bone)
- Carcinoma › ameloblastic › upper jaw (bone)
- Carcinoma › intraosseous › upper jaw (bone)
- Carcinoma › odontogenic › upper jaw (bone)
- Fibrosarcoma › ameloblastic › upper jaw (bone)
C69.6
Malignant neoplasm of orbit
Not billable
- Chapter 2
- Neoplasms
- Section
- C69-C72
Use when the record says
- Malignant neoplasm of connective tissue of orbit
- Malignant neoplasm of extraocular muscle
- Malignant neoplasm of peripheral nerves of orbit
- Malignant neoplasm of retrobulbar tissue
- Malignant neoplasm of retro-ocular tissue
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