Q37 vs Q38.5
Q37 and Q38.5 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 Q38.5
cleft palate with cleft lip (Q37.-)
Q37
Cleft palate with cleft lip
Not billable
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q35-Q37
Use when the record says
- cheilopalatoschisis
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 (of) (organ or part) (complete or partial)
- Agenesis › uvula
- Anomaly, anomalous › palateNEC (congenital) (unspecified type)
- Anomaly, anomalous › uvula (congenital) (unspecified type)
- Deformity › palate
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