Excludes1 pair
I13- vs I51.5
I13 and I51.5 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.
The official note, declared on I51.5
myocardial degeneration due to hypertension and chronic kidney disease (I13.-)
I13
Hypertensive heart and chronic kidney disease
Not billable
- Chapter 9
- Diseases of the circulatory system
- Section
- I10-I1A
Use when the record says
- any condition in I11.- with any condition in I12.-
- cardiorenal disease
- cardiovascular renal disease
I51.5
Myocardial degeneration
Billable
- Chapter 9
- Diseases of the circulatory system
- Section
- I30-I5A
Use when the record says
- Fatty degeneration of heart or myocardium
- Myocardial disease
- Senile degeneration of heart or myocardium
Indexed under
- Cardiomalacia
- Cardiomyoliposis
- Myocytolysis
- Degeneration, degenerative › myocardial, myocardium (fatty) (hyaline) (senile)
- Disease, diseased › myocardium, myocardial
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