N89.5 vs Q52.4
N89.5 and Q52.4 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 N89.5
congenital atresia or stricture (Q52.4)
N89.5
Stricture and atresia of vagina
Billable
- Chapter 14
- Diseases of the genitourinary system
- Section
- N80-N98
Use when the record says
- Vaginal adhesions
- Vaginal stenosis
Indexed under
- Adhesions, adhesive › vagina (postinfective)
- Band › vagina (s)
- Closure › vagina
- Contraction, contracture, contracted › vagina (s)
- Obstruction, obstructed, obstructive › vagina
Q52.4
Other congenital malformations of vagina
Billable
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q50-Q56
Use when the record says
- Canal of Nuck cyst, congenital
- Congenital malformation of vagina NOS
- Embryonic vaginal cyst
- Gartner's duct cyst
Indexed under
- Absence › hymen (of) (organ or part) (complete or partial)
- Accessory › hymen (congenital)
- Agenesis › hymen
- Anomaly, anomalous › canal of Nuck (congenital) (unspecified type)
- Anomaly, anomalous › Gartner's duct (congenital) (unspecified type)
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