FY2027
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Excludes1 pair

A41.9 vs A48.3

A41.9 and A48.3 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 A48.3
sepsis NOS (A41.9)
A41.9

Sepsis, unspecified organism

BillableUnspecified
Chapter 1
Certain infectious and parasitic diseases
Section
A30-A49
Use when the record says
  • Septicemia NOS
Indexed under
  • Sepsis (generalized) (unspecified organism)
  • Septicemia
  • Sepsis › cryptogenic
  • Sepsis › gangrenous
  • Disorder › tubulo-interstitial › sepsis
A48.3

Toxic shock syndrome

Billable
Chapter 1
Certain infectious and parasitic diseases
Section
A30-A49
Indexed under
  • Shock › toxic, syndrome
  • Syndrome › toxic shock
  • Toxic › shock syndrome
  • Syndrome › shock › toxic

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