K13.0 vs Q38.0
K13.0 and Q38.0 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 K13.0
congenital fistula of lips (Q38.0)
K13.0
Diseases of lips
Billable
- Chapter 11
- Diseases of the digestive system
- Section
- K00-K14
Use when the record says
- Abscess of lips
- Angular cheilitis
- Cellulitis of lips
- Cheilitis NOS
- Cheilodynia
- Cheilosis
- Exfoliative cheilitis
- Fistula of lips
Indexed under
- Angulus infectiosus (lips)
- Baelz's disease (cheilitis glandularis apostematosa)
- Cheilitis (acute) (angular) (catarrhal) (chronic) (exfoliative) (gangrenous) (glandular) (infectional) (suppurative) (ulcerative) (vesicular)
- Cheilodynia
- Cheilosis (angular)
Q38.0
Congenital malformations of lips, not elsewhere classified
BillableUnspecified
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q38-Q45
Use when the record says
- Congenital fistula of lip
- Congenital malformation of lip NOS
- Van der Woude's syndrome
Indexed under
- Van der Woude's syndrome
- Agenesis › lip
- Anomaly, anomalous › lip (congenital) (unspecified type)
- Malformation › lip (congenital)
- Deformity › lipNEC › 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