FY2027
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Excludes1 pair

J93- vs P25.1

J93 and P25.1 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 J93
congenital or perinatal pneumothorax (P25.1)
J93

Pneumothorax and air leak

Not billable
Chapter 10
Diseases of the respiratory system
Section
J90-J94
P25.1

Pneumothorax originating in the perinatal period

Billable
Chapter 16
Certain conditions originating in the perinatal period
Section
P19-P29
Indexed under
  • Pneumothorax NOS › congenital
  • Pneumothorax NOS › perinatal period
  • Pneumothorax NOS › spontaneous NOS › 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