FY2027
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Excludes1 pair

Q68.1 vs R68.3

Q68.1 and R68.3 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 R68.3
congenital clubfinger (Q68.1)
Q68.1

Congenital deformity of finger(s) and hand

Billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q65-Q79
Use when the record says
  • Congenital clubfinger
  • Spade-like hand (congenital)
Indexed under
  • Spade-like hand (congenital)
  • Clawhand › congenital
  • Clubfinger › congenital
  • Distortion › finger (s)
  • Distortion › hand bone (s)
R68.3

Clubbing of fingers

Billable
Chapter 18
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
Section
R50-R69
Use when the record says
  • Clubbing of nails
Indexed under
  • Clubbing of finger (s) (nails)
  • Clubfinger
  • Clubnail

These two codes sit in different chapters of the Tabular List, which is usually the clearest signal that they describe different underlying processes rather than different degrees of the same one.

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