Excludes1 pair
P12.0 vs P13.1
P12.0 and P13.1 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 P13.1
cephalhematoma (P12.0)
P12.0
Cephalhematoma due to birth injury
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P10-P15
Indexed under
- Cephalematoma, cephalhematoma › newborn (birth injury)
P13.1
Other birth injuries to skull
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P10-P15
Indexed under
- Rupture, ruptured › fontanel
- Birth › injury NOS › skull NEC
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