P23.0 vs P35.0
P23.0 and P35.0 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 P23.0
congenital rubella pneumonitis (P35.0)
P23.0
Congenital pneumonia due to viral agent
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P19-P29
Indexed under
- Pneumonia › viral, virus › congenital (acute) (double) (migratory) (purulent) (septic) (unresolved)
- Pneumonia › congenital › due to › viral agent (acute) (double) (migratory) (purulent) (septic) (unresolved)
P35.0
Congenital rubella syndrome
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P35-P39
Use when the record says
- Congenital rubella pneumonitis
Indexed under
- Pneumonitis › congenital rubella (acute) (primary)
- Pneumonitis › rubella, congenital (acute) (primary)
- Rubella › congenital (German measles)
- Syndrome › rubella
- Infection, infected, infective › congenital › rubella (opportunistic)
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