Excludes1 pair
F22 vs F31.5
F22 and F31.5 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.
F22
Delusional disorders
Billable
- Chapter 5
- Mental, Behavioral and Neurodevelopmental disorders
- Section
- F20-F29
Use when the record says
- Delusional dysmorphophobia
- Involutional paranoid state
- Paranoia
- Paranoia querulans
- Paranoid psychosis
- Paranoid state
- Paraphrenia (late)
- Sensitiver Beziehungswahn
Indexed under
- Cotard's syndrome
- Lycanthropy
- Paranoia (querulans)
- Paraphrenia, paraphrenic (late)
- Sander's disease (paranoia)
F31.5
Bipolar disorder, current episode depressed, severe, with psychotic features
Billable
- Chapter 5
- Mental, Behavioral and Neurodevelopmental disorders
- Section
- F30-F39
Use when the record says
- Bipolar disorder, current episode depressed with mood-incongruent psychotic symptoms
- Bipolar disorder, current episode depressed with mood-congruent psychotic symptoms
- Bipolar I disorder, current or most recent episode depressed, with psychotic features
Indexed under
- Disorder › bipolar › current episode › depressed › with psychotic features
- Disorder › bipolar › current episode › severe depression › with psychotic features
- Disorder › bipolar › current episode › depressed › without psychotic features › severe › with psychotic features
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