FY2027
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Excludes1 pair

Q18- vs Q67.4

Q18 and Q67.4 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 Q18
conditions classified to Q67.0-Q67.4
Q18

Other congenital malformations of face and neck

Not billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q10-Q18
Q67.4

Other congenital deformities of skull, face and jaw

Billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q65-Q79
Use when the record says
  • Congenital depressions in skull
  • Congenital hemifacial atrophy or hypertrophy
  • Deviation of nasal septum, congenital
  • Squashed or bent nose, congenital
Indexed under
  • Atrophy, atrophic › hemifacial
  • Depression › skull
  • Flattening › nose (congenital)
  • Friedreich's › facial hemihypertrophy
  • Hypertrophy, hypertrophic › hemifacial

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