K22.3 vs S27
K22.3 and S27 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 K22.3
traumatic perforation of (thoracic) esophagus (S27.8-)
K22.3
Perforation of esophagus
Billable
- Chapter 11
- Diseases of the digestive system
- Section
- K20-K31
Use when the record says
- Rupture of esophagus
Indexed under
- Boerhaave's syndrome (spontaneous esophageal rupture)
- Perforation, perforated › esophagus (nontraumatic) (of)
- Rupture, ruptured › esophagus
- Syndrome › Boerhaave's
S27
Injury of other and unspecified intrathoracic organs
Not billable
- Chapter 19
- Injury, poisoning and certain other consequences of external causes
- Section
- S20-S29
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