FY2027
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Excludes1 pair

E66.2 vs G47.3-

E66.2 and G47.3 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 G47.3
pickwickian syndrome (E66.2)
E66.2

Morbid (severe) obesity with alveolar hypoventilation

Billable
Chapter 4
Endocrine, nutritional and metabolic diseases
Section
E65-E68
Use when the record says
  • Obesity hypoventilation syndrome (OHS)
  • Pickwickian syndrome
Indexed under
  • OHS (obesity hypoventilation syndrome)
  • Pickwickian syndrome
  • Obesity › with alveolar hypoventilation
  • Obesity › hypoventilation syndrome (OHS)
  • Syndrome › alveolar hypoventilation
G47.3

Sleep apnea

Not billable
Chapter 6
Diseases of the nervous system
Section
G40-G47

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