E74.4 vs E88.4
E74.4 and E88.4 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 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 (of)
- Disorder › pyruvate metabolism (of)
- 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