FY2027
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Excludes1 pair

K22.3 vs S27-

K22.3 and S27 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 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
  • 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