Excludes1 pair

E50.8 vs L86

E50.8 and L86 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 L86
keratoderma due to vitamin A deficiency (E50.8)
E50.8

Other manifestations of vitamin A deficiency

Billable
Chapter 4
Endocrine, nutritional and metabolic diseases
Section
E50-E64
Use when the record says
  • Follicular keratosis
  • Xeroderma
Indexed under
  • Phrynoderma (vitamin A deficiency)
  • Keratosis › vitamin A deficiency
  • Xeroderma › vitamin A deficiency
  • Keratosis › follicularis › vitamin A deficiency
  • Deficiency, deficient › vitamin NOS › A › with › follicular keratosis
L86

Keratoderma in diseases classified elsewhere

Billable
Chapter 12
Diseases of the skin and subcutaneous tissue
Section
L80-L99
Indexed under
  • Keratoderma, keratodermia › acquired › in diseases classified elsewhere

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