Excludes1 pair
E03.1 vs E03.4
E03.1 and E03.4 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 distinction is congenital vs acquired.
The official note, declared on E03.4
congenital atrophy of thyroid (E03.1)
E03.1
Congenital hypothyroidism without goiter
Billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E00-E07
Use when the record says
- Aplasia of thyroid (with myxedema)
- Congenital atrophy of thyroid
- Congenital hypothyroidism NOS
Indexed under
- Agenesis › thyroid (gland)
- Aplasia › thyroid (congenital) (with myxedema)
- Athyrea › congenital
- Hypoplasia, hypoplastic › thyroid (gland)
- Hypothyroidism › congenital (without goiter)
E03.4
Atrophy of thyroid (acquired)
Billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E00-E07
Indexed under
- Gull's disease
- Strumipriva cachexia
- Atrophy, atrophic › thyroid (gland) (acquired)
- Cachexia › strumipriva
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