Q43.6 vs Q52.2
Q43.6 and Q52.2 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 Q43.6
congenital rectovaginal fistula (Q52.2)
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 (cutaneous)
- Fistula › fecal › congenital (cutaneous)
- Fistula › rectum › congenital (cutaneous)
Q52.2
Congenital rectovaginal fistula
Billable
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q50-Q56
Indexed under
- Fistula › enterovaginal › congenital (cutaneous)
- Fistula › rectovaginal › congenital (cutaneous)
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