FY2027
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Excludes1 pair

P54.5 vs R23.3

P54.5 and R23.3 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 R23.3
ecchymoses of newborn (P54.5)
P54.5

Neonatal cutaneous hemorrhage

Billable
Chapter 16
Certain conditions originating in the perinatal period
Section
P50-P61
Use when the record says
  • Neonatal bruising
  • Neonatal ecchymoses
  • Neonatal petechiae
  • Neonatal superficial hematomata
Indexed under
  • Bruise › newborn
  • Contusion › newborn
  • Ecchymosis › newborn
  • Hematoma › superficial, newborn
  • Morbus › maculosus neonatorum
R23.3

Spontaneous ecchymoses

Billable
Chapter 18
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
Section
R20-R23
Use when the record says
  • Petechiae
Indexed under
  • Petechia, petechiae
  • Purpuric spots
  • Cutaneous › hemorrhage
  • Ecchymosis › spontaneous
  • Hemorrhage, hemorrhagic › cutaneous

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