Excludes1 pair

B02.8 vs H62.4-

B02.8 and H62.4 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 H62.4
herpes zoster (B02.8)
B02.8

Zoster with other complications

Billable
Chapter 1
Certain infectious and parasitic diseases
Section
B00-B09
Use when the record says
  • Herpes zoster otitis externa
Indexed under
  • Herpes, herpesvirus, herpetic › zoster › complicated NEC
  • Herpes, herpesvirus, herpetic › zoster › specified complication NEC
  • Otitis › externa › in › zoster
  • Otitis › externa › in › herpes virus infection › zoster
H62.4

Otitis externa in other diseases classified elsewhere

Not billable
Chapter 8
Diseases of the ear and mastoid process
Section
H60-H62
Indexed under
  • Otomycosis NEC (diffuse)
  • Ear › tropical NEC
  • Erysipelas › external ear
  • Impetigo › external ear
  • Otitis › externa › mycotic NEC

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