J06 vs J11.1
J06 and J11.1 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.
J06
Acute upper respiratory infections of multiple and unspecified sites
Not billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J00-J06
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 (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
- Influenza › with › pharyngitis (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
- Influenza › with › respiratory manifestations NEC (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
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