FY2027
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Excludes1 pair

J00 vs J11.1

J00 and J11.1 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 J00
influenza virus with other respiratory manifestations (J09.X2, J10.1, J11.1)
J00

Acute nasopharyngitis [common cold]

Billable
Chapter 10
Diseases of the respiratory system
Section
J00-J06
Use when the record says
  • Acute rhinitis
  • Coryza (acute)
  • Infective nasopharyngitis NOS
  • Infective rhinitis
  • Nasal catarrh, acute
  • Nasopharyngitis NOS
Indexed under
  • Catarrh, catarrhal (acute) (febrile) (infectious) (inflammation)
  • Cold
  • Coryza (acute)
  • Nasopharyngitis (acute) (infective) (streptococcal) (subacute)
  • Cold › common (head)
J11.1

Influenza due to unidentified influenza virus with other respiratory manifestations

Billable
Chapter 10
Diseases of the respiratory system
Section
J09-J18
Use when the record says
  • Influenza NOS
  • Influenzal laryngitis NOS
  • Influenzal pharyngitis NOS
  • Influenza with upper respiratory symptoms NOS
Indexed under
  • Influenza (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
  • Influenza › with › laryngitis
  • Influenza › with › pharyngitis
  • Influenza › with › respiratory manifestations NEC

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