FY2027
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Excludes1 pair

Q36- vs Q38.0

Q36 and Q38.0 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 Q38.0
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
  • Malformation › lip
  • Deformity › lip NEC › 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