Excludes1 pair
I31- vs I97.0
I31 and I97.0 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 I31
postcardiotomy syndrome (I97.0)
I31
Other diseases of pericardium
Not billable
- Chapter 9
- Diseases of the circulatory system
- Section
- I30-I5A
I97.0
Postcardiotomy syndrome
Billable
- Chapter 9
- Diseases of the circulatory system
- Section
- I95-I99
Indexed under
- Postcardiotomy syndrome
- Postcommissurotomy syndrome
- Postvalvulotomy syndrome
- Injury › postcardiac surgery (syndrome)
- Syndrome › postcardiotomy
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