Excludes1 pair
J35- vs J35.1
J35 and J35.1 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 J35.1
hypertrophy of tonsils with tonsillitis (J35.0-)
J35
Chronic diseases of tonsils and adenoids
Not billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J30-J39
J35.1
Hypertrophy of tonsils
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J30-J39
Use when the record says
- Enlargement of tonsils
Indexed under
- Enlargement, enlarged › tonsils
- Hyperplasia, hyperplastic › tonsils (faucial) (infective) (lingual) (lymphoid)
- Hypertrophy, hypertrophic › lingual tonsil (infective)
- Hypertrophy, hypertrophic › tonsils (faucial) (infective) (lingual) (lymphoid)
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