Excludes1 pair
E74.4 vs E88.4-
E74.4 and E88.4 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 E88.4
disorders of pyruvate metabolism (E74.4)
E74.4
Disorders of pyruvate metabolism and gluconeogenesis
Billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E70-E88
Use when the record says
- Deficiency of phosphoenolpyruvate carboxykinase
- Deficiency of pyruvate carboxylase
- Deficiency of pyruvate dehydrogenase
Indexed under
- Deficiency, deficient › phosphoenolpyruvate carboxykinase
- Disorder › gluconeogenesis
- Disorder › pyruvate metabolism
- Deficiency, deficient › pyruvate › carboxylase
- Deficiency, deficient › pyruvate › dehydrogenase
E88.4
Mitochondrial metabolism disorders
Not billable
- Chapter 4
- Endocrine, nutritional and metabolic diseases
- Section
- E70-E88
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