FY2027
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Excludes1 pair

J03.9- vs J10.1

J03.9 and J10.1 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 J03.9
influenza virus with other respiratory manifestations (J09.X2, J10.1, J11.1)
J03.9

Acute tonsillitis, unspecified

Not billable
Chapter 10
Diseases of the respiratory system
Section
J00-J06
Use when the record says
  • Follicular tonsillitis (acute)
  • Gangrenous tonsillitis (acute)
  • Infective tonsillitis (acute)
  • Tonsillitis (acute) NOS
  • Ulcerative tonsillitis (acute)
J10.1

Influenza due to other identified influenza virus with other respiratory manifestations

Billable
Chapter 10
Diseases of the respiratory system
Section
J09-J18
Use when the record says
  • Influenza due to other identified influenza virus NOS
  • Influenza due to other identified influenza virus with laryngitis
  • Influenza due to other identified influenza virus with pharyngitis
  • Influenza due to other identified influenza virus with upper respiratory symptoms
Indexed under
  • Influenza › novel H1N1 influenza (2009)
  • Influenza › novel influenza A/H1N1
  • Influenza › due to › identified influenza virus NEC
  • Influenza › due to › identified influenza virus NEC › with › laryngitis
  • Influenza › due to › identified influenza virus NEC › with › pharyngitis

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