FY2027
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Excludes1 pair

P04.1- vs Q86.1

P04.1 and Q86.1 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 P04.1
fetal hydantoin syndrome (Q86.1)
P04.1

Newborn affected by other maternal medication

Not billable
Chapter 16
Certain conditions originating in the perinatal period
Section
P00-P04
Q86.1

Fetal hydantoin syndrome

Billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q80-Q89
Use when the record says
  • Meadow's syndrome
Indexed under
  • Meadow's syndrome
  • Dysmorphism › hydantoin
  • Fetus, fetal › hydantoin syndrome
  • Syndrome › fetal › hydantoin
  • Syndrome › malformation, congenital, due to › hydantoin

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