Excludes1 pair

D68.4 vs P53

D68.4 and P53 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 D68.4
vitamin K deficiency of newborn (P53)
D68.4

Acquired coagulation factor deficiency

Billable
Chapter 3
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
Section
D65-D69
Use when the record says
  • Deficiency of coagulation factor due to liver disease
  • Deficiency of coagulation factor due to vitamin K deficiency
Indexed under
  • Hyperprothrombinemia, causing coagulation factor deficiency
  • Fibrinopenia › acquired
  • Hemophilia › calcipriva
  • Hemophilia › nonfamilial
  • Hypoprothrombinemia › acquired
P53

Hemorrhagic disease of newborn

Billable
Chapter 16
Certain conditions originating in the perinatal period
Section
P50-P61
Use when the record says
  • Vitamin K deficiency of newborn
Indexed under
  • Minot's disease, newborn (hemorrhagic disease)
  • Disease, diseased › Minot's (hemorrhagic disease, newborn)
  • Morbus › hemorrhagicus neonatorum
  • Deficiency, deficient › menadione › newborn
  • Deficiency, deficient › thrombokinase › newborn

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