F29 vs R46-
F29 and R46 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.
Unspecified psychosis not due to a substance or known physiological condition
- Chapter 5
- Mental, Behavioral and Neurodevelopmental disorders
- Section
- F20-F29
- Psychosis NOS
- Unspecified schizophrenia spectrum and other psychotic disorder
- Psychosis, psychotic
- Disorder › schizophrenia spectrum and other psychotic disorder
- Psychosis, psychotic › confusional
- Psychosis, psychotic › nonorganic
- Schizophrenia, schizophrenic › spectrum and other psychotic disorder
Symptoms and signs involving appearance and behavior
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R40-R46
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