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Q35.1 ICD-10-CM Code: Cleft hard palate

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
2 inclusion terms · 1 Excludes1 · 1 Excludes2 · 1 use-additional code

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 011 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC (MDC PRE)
  • MS-DRG 012 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC (MDC PRE)
  • MS-DRG 013 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC (MDC PRE)
  • MS-DRG 157 — DENTAL AND ORAL DISEASES WITH MCC (MDC 03)
  • MS-DRG 158 — DENTAL AND ORAL DISEASES WITH CC (MDC 03)
  • MS-DRG 159 — DENTAL AND ORAL DISEASES WITHOUT CC/MCC (MDC 03)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for Q35.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on Q35.1 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • fissure of palate
  • palatoschisis

Source: inherited from Q35

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from Q35

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from Q35-Q37

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify associated malformation of the nose (Q30.2)

Source: inherited from Q35-Q37

Coder workflow for Q35.1

MedCoder structured workflow — derived from this code’s own official record

Before you code Q35.1

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with Q35.1. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in Q35.1’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewQ37

Consider Q35.1. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting Q35.1(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with Q35.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareQ37

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of Q35.1(1 note)

    Coding workflow: The conditions named in this note are not included in Q35.1. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareQ87.0

    See the official tabular notes · Guidelines I.A.12.b

  • Use Additional Code — after identifying Q35.1(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with Q35.1 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewQ30.2

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition Q35.1 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewQ37

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with Q35.1?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewQ30.2

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Cleft hard palate is a billable ICD-10-CM diagnosis code (Q35.1).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 1 Excludes2 entry — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name Q35.1 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes1 notes: Q18 — Other congenital malformations of face and neck (via Q35.-), Q38.5 — Congenital malformations of palate, not elsewhere classified (via Q35.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 9 Excludes2 notes: Q10 — Congenital malformations of eyelid, lacrimal apparatus and orbit (via Q35.-), Q10-Q18 — Congenital malformations of eye, ear, face and neck (Q10-Q18) (via Q35.-), Q11 — Anophthalmos, microphthalmos and macrophthalmos (via Q35.-), Q12 — Congenital lens malformations (via Q35.-), Q13 — Congenital malformations of anterior segment of eye (via Q35.-), Q14 — Congenital malformations of posterior segment of eye (via Q35.-), Q15 — Other congenital malformations of eye (via Q35.-), Q16 — Congenital malformations of ear causing impairment of hearing (via Q35.-), Q17 — Other congenital malformations of ear (via Q35.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 6 MS-DRGs: DRG 011 (MDC PRE), DRG 012 (MDC PRE), DRG 013 (MDC PRE), DRG 157 (MDC 03), DRG 158 (MDC 03), DRG 159 (MDC 03).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MAL006 — Cleft lip or palate (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Cleft lip or palate).

Q35.3 — Cleft soft palate, Q35.5 — Cleft hard palate with cleft soft palate, Q35.7 — Cleft uvula, Q35.9 — Cleft palate, unspecified, Q36.0 — Cleft lip, bilateral, Q36.1 — Cleft lip, median, Q36.9 — Cleft lip, unilateral, Q37.0 — Cleft hard palate with bilateral cleft lip, Q37.1 — Cleft hard palate with unilateral cleft lip, Q37.2 — Cleft soft palate with bilateral cleft lip, Q37.3 — Cleft soft palate with unilateral cleft lip, Q37.4 — Cleft hard and soft palate with bilateral cleft lip, Q37.5 — Cleft hard and soft palate with unilateral cleft lip, Q37.8 — Unspecified cleft palate with bilateral cleft lip, Q37.9 — Unspecified cleft palate with unilateral cleft lip

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Cleft”, “Perforation, perforated”; these codes share that main term but sit in a different category of the Tabular List.

O71.6 — Obstetric damage to pelvic joints and ligaments (broad ligament, obstetrical trauma), P78.0 — Perinatal intestinal perforation (bowel, newborn), Q18.0 — Sinus, fistula and cyst of branchial cleft (branchial, cyst), Q18.2 — Other branchial cleft malformations (branchial), Q21.19 — Other specified atrial septal defect (atrial septum, multiple), Q23.82 — Congenital mitral valve cleft leaflet (mitral valve leaflet), Q30.2 — Fissured, notched and cleft nose (nose), Q30.3 — Congenital perforated nasal septum (nasal, septum, congenital), Q30.8 — Other congenital malformations of nose (nasal, sinus, congenital), Q31.8 — Other congenital malformations of larynx (thyroid cartilage), Q36.0 — Cleft lip, bilateral (lip, bilateral), Q36.1 — Cleft lip, median (lip, median), Q36.9 — Cleft lip, unilateral (lip), Q37.0 — Cleft hard palate with bilateral cleft lip (lip, bilateral, with cleft palate, hard), Q37.1 — Cleft hard palate with unilateral cleft lip (lip, with cleft palate, hard), Q37.2 — Cleft soft palate with bilateral cleft lip (lip, bilateral, with cleft palate, soft), Q37.3 — Cleft soft palate with unilateral cleft lip (lip, with cleft palate, soft), Q37.4 — Cleft hard and soft palate with bilateral cleft lip (lip, bilateral, with cleft palate, soft, with hard), Q37.5 — Cleft hard and soft palate with unilateral cleft lip (lip, with cleft palate, hard, with soft), Q37.8 — Unspecified cleft palate with bilateral cleft lip (lip, bilateral, with cleft palate), +83 more

Contextual Map

Every relationship of Q35.1 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run Q35.1 with these 10 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes (9)

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • Pre-MDC[MDC crossing]: “Pre-MDC — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 153 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 03 — Diseases and Disorders of the Ear, Nose, Mouth and Throat[MDC crossing]: “Diseases and Disorders of the Ear, Nose, Mouth and Throat — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,147 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Cleft (congenital), palate, hard[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Perforation, perforated (nontraumatic) (of), palatine vault[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "Q35.1 — Cleft hard palate." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/q35.1-cleft-hard-palate

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Cleft hard palate

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to Q35.1 in its code family, with their registry titles.

View all codes in the Q35 family