FY2027
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Excludes1 pair

Q42.2 vs Q43.6

Q42.2 and Q43.6 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 Q43.6
congenital fistula of anus with absence, atresia and stenosis (Q42.2)
Q42.2

Congenital absence, atresia and stenosis of anus with fistula

Billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q38-Q45
Indexed under
  • Absence › anus › with fistula
  • Agenesis › anus, anal › with fistula
  • Atresia, atretic › ani, anus, anal › with fistula
  • Hypoplasia, hypoplastic › anus, anal › with fistula
  • Imperforate › anus › with fistula
Q43.6

Congenital fistula of rectum and anus

Billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q38-Q45
Indexed under
  • Fistula › anus, anal › congenital
  • Fistula › fecal › congenital
  • Fistula › rectum › 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