Excludes1 pair
E52 vs E64.8
E52 and E64.8 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 E52
sequelae of niacin deficiency (E64.8)
E52
Niacin deficiency [pellagra]
Billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E50-E64
Use when the record says
- Niacin (-tryptophan) deficiency
- Nicotinamide deficiency
- Pellagra (alcoholic)
Indexed under
- Niacin deficiency (amide)
- Nicotinic acid deficiency
- Pellagra (alcoholic)
- Alcohol, alcoholic, alcohol-induced › pellagra
- Avitaminosis › nicotinic acid
E64.8
Sequelae of other nutritional deficiencies
Billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E50-E64
Indexed under
- Sequelae › calcium deficiency
- Sequelae › niacin deficiency
- Sequelae › selenium deficiency
- Sequelae › thiamine deficiency
- Sequelae › vitamin deficiency NEC
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