Excludes1 pair
E46 vs E63.9
E46 and E63.9 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 E46
nutritional deficiency NOS (E63.9)
E46
Unspecified protein-calorie malnutrition
BillableUnspecified
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E40-E46
Use when the record says
- Malnutrition NOS
- Protein-calorie imbalance NOS
Indexed under
- Calorie deficiency or malnutrition
- Malnutrition
- Cataract › malnutrition-dehydration
- Deficiency, deficient › protein
- Malnutrition › protein
E63.9
Nutritional deficiency, unspecified
BillableUnspecified
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E50-E64
Indexed under
- Nutrition deficient or insufficient
- Cardiomyopathy › nutritional
- Deficiency, deficient › diet
- Deficiency, deficient › nutrition, nutritional
- Dietary › inadequacy or deficiency
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