Q36 vs Q38.0
Q36 and Q38.0 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on Q38.0
cleft lip (Q36.-)
Q36
Cleft lip
Not billable
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q35-Q37
Use when the record says
- cheiloschisis
- congenital fissure of lip
- harelip
- labium leporinum
Q38.0
Congenital malformations of lips, not elsewhere classified
BillableUnspecified
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q38-Q45
Use when the record says
- Congenital fistula of lip
- Congenital malformation of lip NOS
- Van der Woude's syndrome
Indexed under
- Van der Woude's syndrome
- Agenesis › lip
- Anomaly, anomalous › lip (congenital) (unspecified type)
- Malformation › lip (congenital)
- Deformity › lipNEC › 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