FY2027
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Excludes1 pair

Q03- vs Q05.4

Q03 and Q05.4 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 Q03
hydrocephalus with spina bifida (Q05.0-Q05.4)
Q03

Congenital hydrocephalus

Not billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q00-Q07
Use when the record says
  • hydrocephalus in newborn
Q05.4

Unspecified spina bifida with hydrocephalus

BillableUnspecified
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q00-Q07
Indexed under
  • Spina bifida › with hydrocephalus NEC
  • Hydrocephalus › congenital › with spina bifida

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