H49 vs H49.4
H49 and H49.4 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 H49.4
Kearns-Sayre syndrome (H49.81-)
H49.4
Progressive external ophthalmoplegia
Not billable
- Chapter 7
- Diseases of the eye and adnexa
- Section
- H49-H52
Indexed under
- Ophthalmoplegia › external › progressive
- Strabismus › paralytic › ophthalmoplegia › progressive (congenital) (nonparalytic)
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