Excludes1 pair
N36.0 vs N82.1
N36.0 and N82.1 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 N36.0
urethrovaginal fistula (N82.1)
N36.0
Urethral fistula
Billable
- Chapter 14
- Diseases of the genitourinary system
- Section
- N30-N39
Use when the record says
- Urethroperineal fistula
- Urethrorectal fistula
- Urinary fistula NOS
Indexed under
- Fistula › perineum, perineal NEC (with urethral involvement)
- Fistula › rectourethral
- Fistula › urethra
- Fistula › urethroperineal
- Fistula › urethrorectal
N82.1
Other female urinary-genital tract fistulae
Billable
- Chapter 14
- Diseases of the genitourinary system
- Section
- N80-N98
Use when the record says
- Cervicovesical fistula
- Ureterovaginal fistula
- Urethrovaginal fistula
- Uteroureteric fistula
- Uterovesical fistula
Indexed under
- Fistula › cervicovesical
- Fistula › ureterovaginal
- Fistula › urethrovaginal
- Fistula › uteroureteric
- Fistula › uterovesical
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