E03.1 vs P72
E03.1 and P72 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 P72
congenital hypothyroidism with or without goiter (E03.0-E03.1)
E03.1
Congenital hypothyroidism without goiter
Billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E00-E07
Use when the record says
- Aplasia of thyroid (with myxedema)
- Congenital atrophy of thyroid
- Congenital hypothyroidism NOS
Indexed under
- Agenesis › thyroid
- Aplasia › thyroid
- Athyrea › congenital (acquired)
- Hypoplasia, hypoplastic › thyroid
- Hypothyroidism › congenital (acquired)
P72
Other transitory neonatal endocrine disorders
Not billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P70-P74
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