FY2027
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Excludes1 pair

K60.4- vs N82.3

K60.4 and N82.3 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 K60.4
rectovaginal fistula (N82.3)
K60.4

Rectal fistula

Not billable
Chapter 11
Diseases of the digestive system
Section
K55-K64
Use when the record says
  • Fistula of rectum to skin
N82.3

Fistula of vagina to large intestine

Billable
Chapter 14
Diseases of the genitourinary system
Section
N80-N98
Use when the record says
  • Rectovaginal fistula
Indexed under
  • Fistula › rectovaginal
  • Fistula › rectovesicovaginal
  • Fistula › vesicosigmoidovaginal
  • Sinus › rectovaginal
  • Fistula › enterovaginal › large intestine

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