Excludes1 pair
Q43.7 vs Q52.2
Q43.7 and Q52.2 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 Q52.2
cloaca (Q43.7)
Q43.7
Persistent cloaca
Billable
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q38-Q45
Use when the record says
- Cloaca NOS
Indexed under
- Cloaca (persistent)
- Persistence, persistent › cloaca
Q52.2
Congenital rectovaginal fistula
Billable
- Chapter 17
- Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
- Section
- Q50-Q56
Indexed under
- Fistula › enterovaginal › congenital
- Fistula › rectovaginal › 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