Excludes1 pair
I89.0 vs I97.2
I89.0 and I97.2 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 I89.0
postmastectomy lymphedema (I97.2)
I89.0
Lymphedema, not elsewhere classified
BillableUnspecified
- Chapter 9
- Diseases of the circulatory system
- Section
- I80-I89
Use when the record says
- Elephantiasis (nonfilarial) NOS
- Lymphangiectasis
- Obliteration, lymphatic vessel
- Praecox lymphedema
- Secondary lymphedema
Indexed under
- Elephantiasis (nonfilarial)
- Lymphangiectasis
- Lymphangiectatic elephantiasis, nonfilarial
- Lymphectasia
- Compression › lymphatic vessel
I97.2
Postmastectomy lymphedema syndrome
Billable
- Chapter 9
- Diseases of the circulatory system
- Section
- I95-I99
Use when the record says
- Elephantiasis due to mastectomy
- Obliteration of lymphatic vessels
Indexed under
- Postmastectomy lymphedema (syndrome)
- Lymphedema › postmastectomy
- Syndrome › postmastectomy lymphedema
- Complication › surgical procedure › postmastectomy lymphedema syndrome
- Edema, edematous › lymphatic › due to mastectomy
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