Excludes1 pair
J02.9 vs J11.1
J02.9 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.
J02.9
Acute pharyngitis, unspecified
BillableUnspecified
- Chapter 10
- Diseases of the respiratory system
- Section
- J00-J06
Use when the record says
- Gangrenous pharyngitis (acute)
- Infective pharyngitis (acute) NOS
- Pharyngitis (acute) NOS
- Sore throat (acute) NOS
- Suppurative pharyngitis (acute)
- Ulcerative pharyngitis (acute)
Indexed under
- Faucitis
- Pharyngitis (acute) (catarrhal)(gangrenous) (infective) (malignant) (membranous) (phlegmonous) (pseudomembranous) (simple) (subacute) (suppurative) (ulcerative)
- Necrosis, necrotic › pharynx
- Pharyngitis › purulent
- Pharyngitis › putrid
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