FY2027
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Excludes1 pair

Q35- vs Q38.5

Q35 and Q38.5 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 Q38.5
cleft palate (Q35.-)
Q35

Cleft palate

Not billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q35-Q37
Use when the record says
  • fissure of palate
  • palatoschisis
Q38.5

Congenital malformations of palate, not elsewhere classified

BillableUnspecified
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q38-Q45
Use when the record says
  • Congenital absence of uvula
  • Congenital malformation of palate NOS
  • Congenital high arched palate
Indexed under
  • Absence › uvula, congenital
  • Agenesis › uvula
  • Anomaly, anomalous › palate NEC (hard) (soft)
  • Anomaly, anomalous › uvula
  • Deformity › palate (congenital)

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