Excludes1 pair
P54.0 vs P78.2
P54.0 and P78.2 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 distinction is perinatal vs later onset.
The official note, declared on P54.0
neonatal hematemesis due to swallowed maternal blood (P78.2)
P54.0
Neonatal hematemesis
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P50-P61
Indexed under
- Hematemesis › newborn, neonatal
P78.2
Neonatal hematemesis and melena due to swallowed maternal blood
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P76-P78
Indexed under
- Melena › due to swallowed maternal blood
- Syndrome › swallowed blood
- Hematemesis › newborn, neonatal › due to swallowed maternal blood
- Melena › newborn, neonatal › due to swallowed maternal blood
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