FY2027
MenuClose
Excludes1 pair

D16.4 vs D31.6-

D16.4 and D31.6 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 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 (bone) (maxilla)
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