FY2027
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Excludes1 pair

E65 vs R22-

E65 and R22 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 R22
localized adiposity (E65)
E65

Localized adiposity

Billable
Chapter 4
Endocrine, nutritional and metabolic diseases
Section
E65-E68
Use when the record says
  • Fat pad
Indexed under
  • Panniculus adiposus (abdominal)
  • Adiposity › localized
  • Fat › localized (pad)
  • Fat › pad
  • Fatty › apron
R22

Localized swelling, mass and lump of skin and subcutaneous tissue

Not billable
Chapter 18
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
Section
R20-R23
Use when the record says
  • subcutaneous nodules (localized)(superficial)

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