Excludes1 pair

A42- vs B47.1

A42 and B47.1 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 A42
actinomycetoma (B47.1)
A42

Actinomycosis

Not billable
Chapter 1
Certain infectious and parasitic diseases
Section
A30-A49
B47.1

Actinomycetoma

Billable
Chapter 1
Certain infectious and parasitic diseases
Section
B35-B49
Indexed under
  • Actinomycetoma (foot)
  • Streptomycosis
  • Infection, infected, infective › Actinomadura
  • Infection, infected, infective › Streptomyces
  • Mycetoma › actinomycotic

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