FY2027
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Excludes1 pair

P23.0 vs P35.0

P23.0 and P35.0 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 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
  • Pneumonia › congenital › due to › viral agent
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
  • Pneumonitis › rubella, congenital
  • Rubella › congenital
  • Syndrome › rubella (congenital)
  • Infection, infected, infective › congenital › rubella

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