D16.4 vs D31.6
D16.4 and D31.6 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on D31.6
benign neoplasm of orbital bone (D16.4)
D16.4
Benign neoplasm of bones of skull and face
Billable
- Chapter 2
- Neoplasms
- Section
- D10-D36
Use when the record says
- Benign neoplasm of maxilla (superior)
- Benign neoplasm of orbital bone
- Keratocyst of maxilla
- Keratocystic odontogenic tumor of maxilla
Indexed under
- Cyst › calcifying odontogenic › upper jaw (colloid) (mucous) (simple) (retention)
D31.6
Benign neoplasm of unspecified site of orbit
Not billable
- Chapter 2
- Neoplasms
- Section
- D10-D36
Use when the record says
- Benign neoplasm of connective tissue of orbit
- Benign neoplasm of extraocular muscle
- Benign neoplasm of peripheral nerves of orbit
- Benign neoplasm of retrobulbar tissue
- Benign neoplasm of retro-ocular tissue
Indexed under
- Nevus › orbit
- Nevus › retrobulbar
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