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    v1.0.28
    OpenPayerBilling CodesCleft lip and cleft palateICD-10-CM q36-cleft-lip
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    ICD-10-CM Code For Cleft Lip: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group Q36 includes congenital cleft lip anomalies affecting the upper lip, including unilateral and bilateral clefts and those with varying laterality and complexity. These ICD-10-CM diagnosis codes are used to document congenital structural defects of the lip that may impact feeding, speech, and facial development, capturing laterality and involvement of adjacent tissues. Accurate coding within the ICD-10-CM Q36 group supports proper claim adjudication and complete clinical documentation and appropriate reimbursement.

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    ICD-10-CM Q36: Cleft Lip Overview

    The ICD-10-CM Q36 code group covers congenital cleft lip anomalies of the upper lip and adjacent structures, including unilateral and bilateral presentations. These diagnoses involve craniofacial development and the oral-facial region, often assessed alongside cleft palate. Accurate coding supports appropriate clinical documentation and reimbursement by clearly communicating the specific defect and any surgical or repair planning needs.

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    When to Use

    Use a code from this group when documenting a congenital cleft lip identified at birth or during evaluation that affects the upper lip anatomy. Assign the specific code that reflects laterality and complexity when reporting the diagnosis for clinical records and claims.

    ICD-10-CM Codes

    3 rows

    ICD-10-CM CodeDescription
    Q36.0Cleft lip, bilateral
    Q36.1Cleft lip, median
    Q36.9Cleft lip, unilateral

    DRG Codes

    6 rows

    DRG CodeDescription
    011Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC
    012Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC
    013Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC
    157Dental and Oral Diseases with MCC
    158Dental and Oral Diseases with CC
    159Dental and Oral Diseases without CC/MCC

    Typical Clinical Scenarios

    • A newborn is evaluated in the newborn nursery after delivery and is noted to have a unilateral full-thickness cleft of the upper lip extending through the vermilion and philtrum; the pediatric team documents the congenital malformation and refers to plastic surgery and speech pathology for early feeding support and surgical planning. A diagnosis from this group is assigned to code the congenital clefting of the lip identified at birth. Typical codes: Q36.0.
    • An infant in the outpatient cleft clinic presents for ongoing multidisciplinary care with a repaired bilateral cleft lip, with documented residual scar tissue and nasal asymmetry but no current cleft palate involvement; the visit focuses on growth monitoring, feeding progress, and planning for secondary revision. A code from this group is used to indicate the congenital bilateral cleft lip as part of the child’s chronic congenital condition history. Typical codes: Q36.1.
    • A school-aged child is brought to the emergency department after facial trauma with dehiscence of a previously unrepaired cleft lip causing active bleeding and difficulty with oral competence; the ED documents an acute complication of the underlying congenital lip cleft and coordinates urgent surgical consultation. A diagnosis from this group is assigned to reflect the congenital cleft lip that is complicating the acute presentation. Typical codes: Q36.9.

    Related Codes

    Q35-CLEFT-PALATE

    ICD-10-CM Code For Cleft Palate: Group Overview

    Q37-CLEFT-PALATE-WITH-CLEFT-LIP

    ICD-10-CM Code For Cleft Palate With Cleft Lip: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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