Excludes1 pair
G56.4- vs G90-
G56.4 and G90 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 G56.4
complex regional pain syndrome I of lower limb (G90.52-)
G56.4
Causalgia of upper limb
Not billable
- Chapter 6
- Diseases of the nervous system
- Section
- G50-G59
Use when the record says
- Complex regional pain syndrome II of upper limb
Indexed under
- Causalgia (upper limb)
G90
Disorders of autonomic nervous system
Not billable
- Chapter 6
- Diseases of the nervous system
- Section
- G89-G99
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