Excludes1 pair
J00 vs J31.0
J00 and J31.0 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 distinction is acute vs chronic.
The official note, declared on J00
rhinitis NOS (J31.0)
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)
J31.0
Chronic rhinitis
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J30-J39
Use when the record says
- Atrophic rhinitis (chronic)
- Granulomatous rhinitis (chronic)
- Hypertrophic rhinitis (chronic)
- Obstructive rhinitis (chronic)
- Ozena
- Purulent rhinitis (chronic)
- Rhinitis (chronic) NOS
- Ulcerative rhinitis (chronic)
Indexed under
- Ozena
- Rhinitis (atrophic) (catarrhal) (chronic) (croupous) (fibrinous) (granulomatous) (hyperplastic) (hypertrophic) (membranous) (obstructive) (purulent) (suppurative) (ulcerative)
- Atrophy, atrophic › rhinitis
- Catarrh, catarrhal › chronic
- Congestion, congestive › catarrhal
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