Excludes1 pair

E45 vs R62.5-

E45 and R62.5 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 R62.5
physical retardation due to malnutrition (E45)
E45

Retarded development following protein-calorie malnutrition

Billable
Chapter 4
Endocrine, nutritional and metabolic diseases
Section
E40-E46
Use when the record says
  • Nutritional short stature
  • Nutritional stunting
  • Physical retardation due to malnutrition
Indexed under
  • Nutritional stunting
  • Stunting, nutritional
  • Dwarfism › nutritional
  • Dystrophy, dystrophia › due to malnutrition
  • Dystrophy, dystrophia › nutritional
R62.5

Other and unspecified lack of expected normal physiological development in childhood

Not billable
Chapter 18
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
Section
R50-R69

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