Excludes1 pair

H02- vs Q10.3

H02 and Q10.3 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 H02
congenital malformations of eyelid (Q10.0-Q10.3)
H02

Other disorders of eyelid

Not billable
Chapter 7
Diseases of the eye and adnexa
Section
H00-H05
Q10.3

Other congenital malformations of eyelid

Billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q10-Q18
Use when the record says
  • Ablepharon
  • Blepharophimosis, congenital
  • Coloboma of eyelid
  • Congenital absence or agenesis of cilia
  • Congenital absence or agenesis of eyelid
  • Congenital accessory eyelid
  • Congenital accessory eye muscle
  • Congenital malformation of eyelid NOS
Indexed under
  • Ablepharia, ablepharon
  • Epiblepharon (congenital)
  • Epicanthus, epicanthic fold (eyelid) (congenital)
  • Narrowness, abnormal, eyelid
  • Absence › cilia (congenital)

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