FY2027
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Excludes1 pair

I77.0 vs Z99.2

I77.0 and Z99.2 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 I77.0
presence of arteriovenous shunt (fistula) for dialysis (Z99.2)
I77.0

Arteriovenous fistula, acquired

Billable
Chapter 9
Diseases of the circulatory system
Section
I70-I79
Use when the record says
  • Aneurysmal varix
  • Arteriovenous aneurysm, acquired
Indexed under
  • Fistula › arteriovenous (acquired) (nonruptured)
  • Varicose › aneurysm (ruptured)
  • Varix › aneurysmal
  • Aneurysm › arteriovenous › acquired
  • Aneurysm › arteriovenous › specified site NEC › acquired
Z99.2

Dependence on renal dialysis

Billable
Chapter 21
Factors influencing health status and contact with health services
Section
Z77-Z99
Use when the record says
  • Hemodialysis status
  • Peritoneal dialysis status
  • Presence of arteriovenous shunt for dialysis
  • Renal dialysis status NOS
Indexed under
  • Dialysis › renal, status (hemodialysis) (peritoneal)
  • Presence › arterial-venous shunt (dialysis)
  • Shunt › arterial-venous (dialysis)
  • Status › dialysis (hemodialysis) (peritoneal)
  • Status › renal dialysis (hemodialysis) (peritoneal)

These two codes sit in different chapters of the Tabular List, which is usually the clearest signal that they describe different underlying processes rather than different degrees of the same one.

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