K11.4 vs Q38.4
K11.4 and Q38.4 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 K11.4
congenital fistula of salivary gland (Q38.4)
K11.4
Fistula of salivary gland
Billable
- Chapter 11
- Diseases of the digestive system
- Section
- K00-K14
Indexed under
- Fistula › parotid (cutaneous)
- Fistula › salivary duct or gland (cutaneous)
- Fistula › sublingual gland (cutaneous)
- Fistula › submandibular gland (cutaneous)
- Fistula › submaxillary (cutaneous)
Q38.4
Congenital malformations of salivary glands and ducts
Billable
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q38-Q45
Use when the record says
- Atresia of salivary glands and ducts
- Congenital absence of salivary glands and ducts
- Congenital accessory salivary glands and ducts
- Congenital fistula of salivary gland
Indexed under
- Absence › salivary gland, congenital (of) (organ or part) (complete or partial)
- Accessory › parotid gland (congenital)
- Accessory › salivary gland (congenital)
- Accessory › submaxillary gland (congenital)
- Agenesis › parotid gland
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