Excludes1 pair
I13- vs I51.7
I13 and I51.7 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 I51.7
cardiomegaly 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
I51.7
Cardiomegaly
Billable
- Chapter 9
- Diseases of the circulatory system
- Section
- I30-I5A
Use when the record says
- Cardiac dilatation
- Cardiac hypertrophy
- Ventricular dilatation
Indexed under
- Preponderance, left or right ventricular
- Athlete's › heart
- Cardiomegaly › idiopathic
- Hypertrophy, hypertrophic › cardiac (chronic) (idiopathic)
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