E65 vs R22
E65 and R22 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
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
- 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