FY2027
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Excludes1 pair

E16.1 vs P70.1

E16.1 and P70.1 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 E16.1
hypoglycemia in infant of diabetic mother (P70.1)
E16.1

Other hypoglycemia

Billable
Chapter 4
Endocrine, nutritional and metabolic diseases
Section
E15-E16
Use when the record says
  • Functional hyperinsulinism
  • Functional nonhyperinsulinemic hypoglycemia
  • Hyperinsulinism NOS
  • Hyperplasia of pancreatic islet beta cells NOS
Indexed under
  • Hyperinsulinism (functional)
  • Encephalopathy › posthypoglycemic (coma)
  • Hyperinsulinism › ectopic
  • Hypoglycemia › functional, nonhyperinsulinemic
  • Hypoglycemia › infantile
P70.1

Syndrome of infant of a diabetic mother

Billable
Chapter 16
Certain conditions originating in the perinatal period
Section
P70-P74
Use when the record says
  • Newborn (with hypoglycemia) affected by maternal (pre-existing) diabetes mellitus
Indexed under
  • Hypoglycemia › in infant of diabetic mother
  • Infant › of diabetic mother (syndrome of)
  • Syndrome › infant › of diabetic mother
  • Newborn › affected by › maternal › diabetes mellitus (pre-existing)

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