Excludes1 pair

D14.0 vs H74.4-

D14.0 and H74.4 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 D14.0
polyp of ear (middle) (H74.4)
D14.0

Benign neoplasm of middle ear, nasal cavity and accessory sinuses

Billable
Chapter 2
Neoplasms
Section
D10-D36
Use when the record says
  • Benign neoplasm of cartilage of nose
Indexed under
  • Papilloma › Schneiderian › unspecified site
  • Schneiderian › papilloma › unspecified site
H74.4

Polyp of middle ear

Not billable
Chapter 8
Diseases of the ear and mastoid process
Section
H65-H75
Indexed under
  • Polyp, polypus › ear (middle)

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