Excludes1 pair

D52- vs E53.8

D52 and E53.8 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 D52
folate deficiency without anemia (E53.8)
D52

Folate deficiency anemia

Not billable
Chapter 3
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
Section
D50-D53
E53.8

Deficiency of other specified B group vitamins

BillableUnspecified
Chapter 4
Endocrine, nutritional and metabolic diseases
Section
E50-E64
Use when the record says
  • Biotin deficiency
  • Cyanocobalamin deficiency
  • Folate deficiency
  • Folic acid deficiency
  • Pantothenic acid deficiency
  • Vitamin B12 deficiency
Indexed under
  • Chacaleh
  • Electric feet syndrome
  • Melalgia, nutritional
  • Avitaminosis › B12
  • Deficiency, deficient › biotin

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