Excludes1 pair
K31.6 vs K63.2
K31.6 and K63.2 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 K63.2
fistula of duodenum (K31.6)
K31.6
Fistula of stomach and duodenum
Billable
- Chapter 11
- Diseases of the digestive system
- Section
- K20-K31
Use when the record says
- Gastrocolic fistula
- Gastrojejunocolic fistula
Indexed under
- Fistula › duodenum
- Fistula › gastric
- Fistula › gastrocolic
- Fistula › gastroenterocolic
- Fistula › gastroesophageal
K63.2
Fistula of intestine
Billable
- Chapter 11
- Diseases of the digestive system
- Section
- K55-K64
Indexed under
- Fistula › abdomen (wall)
- Fistula › abdominorectal
- Fistula › abdominosigmoidal
- Fistula › cecosigmoidal
- Fistula › cecum
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