Excludes1 pair
E59 vs E64.8
E59 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 E59
sequelae of selenium deficiency (E64.8)
E59
Dietary selenium deficiency
Billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E50-E64
Use when the record says
- Keshan disease
Indexed under
- Keshan disease
- Selenium deficiency, dietary
- Deficiency, deficient › selenium (dietary)
- Disease, diseased › Keshan
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