J06.9 vs J22
J06.9 and J22 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on J22
upper respiratory infection (acute) (J06.9)
J06.9
Acute upper respiratory infection, unspecified
BillableUnspecified
- Chapter 10
- Diseases of the respiratory system
- Section
- J00-J06
Use when the record says
- Upper respiratory disease, acute
- Upper respiratory infection NOS
Indexed under
- Tracheopharyngitis (acute)
- Inflammation, inflamed, inflammatory › respiratory, upper (with exudation)
- Disease, diseased › respiratory › acute or subacute NOS
- Infection, infected, infective › respiratoryNEC › upperNOS (opportunistic)
- Virus, viral › respiratory syncytial › upper respiratory infection
J22
Unspecified acute lower respiratory infection
BillableUnspecified
- Chapter 10
- Diseases of the respiratory system
- Section
- J20-J22
Use when the record says
- Acute (lower) respiratory (tract) infection NOS
Indexed under
- Infection, infected, infective › chest (opportunistic)
- Infection, infected, infective › respiratoryNEC › acute (opportunistic)
- Infection, infected, infective › respiratoryNEC › lower (opportunistic)
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