FY2027
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Excludes1 pair

A18.6 vs H66.3-

A18.6 and H66.3 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 H66.3
tuberculous otitis media (A18.6)
A18.6

Tuberculosis of (inner) (middle) ear

Billable
Chapter 1
Certain infectious and parasitic diseases
Section
A15-A19
Use when the record says
  • Tuberculous otitis media
Indexed under
  • Tuberculosis, tubercular, tuberculous › ear (inner) (middle)
  • Tuberculosis, tubercular, tuberculous › eustachian tube
  • Tuberculosis, tubercular, tuberculous › otitis media
  • Otitis › media › tuberculous
  • Otitis › media › in › tuberculosis
H66.3

Other chronic suppurative otitis media

Not billable
Chapter 8
Diseases of the ear and mastoid process
Section
H65-H75
Use when the record says
  • Chronic suppurative otitis media NOS
Indexed under
  • Otitis › media › suppurative › chronic

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