K11.4 vs Q38.4
K11.4 and Q38.4 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.
Fistula of salivary gland
- Chapter 11
- Diseases of the digestive system
- Section
- K00-K14
- Fistula › parotid (gland)
- Fistula › salivary duct or gland (any)
- Fistula › sublingual gland
- Fistula › submandibular gland
- Fistula › submaxillary (gland)
Congenital malformations of salivary glands and ducts
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q38-Q45
- Atresia of salivary glands and ducts
- Congenital absence of salivary glands and ducts
- Congenital accessory salivary glands and ducts
- Congenital fistula of salivary gland
- Absence › salivary gland, congenital (s)
- Accessory › parotid gland (and duct)
- Accessory › salivary gland
- Accessory › submaxillary gland
- Agenesis › parotid gland (s)
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