Excludes1 pair
J43.9 vs J98.2
J43.9 and J98.2 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 J98.2
emphysema NOS (J43.9)
J43.9
Emphysema, unspecified
BillableUnspecified
- Chapter 10
- Diseases of the respiratory system
- Section
- J40-J4B
Use when the record says
- Bullous emphysema (lung)(pulmonary)
- Emphysema (lung)(pulmonary) NOS
- Emphysematous bleb
- Vesicular emphysema (lung)(pulmonary)
Indexed under
- Emphysema (atrophic) (bullous) (chronic) (interlobular) (lung) (obstructive) (pulmonary) (senile) (vesicular)
- Bleb › emphysematous (lung) (solitary)
- Bleb › lung (ruptured)
- Bleb › subpleural (emphysematous)
- Bulla › lung (emphysematous) (solitary)
J98.2
Interstitial emphysema
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J96-J99
Use when the record says
- Mediastinal emphysema
Indexed under
- Pneumomediastinum
- Air › anterior mediastinum
- Disease, diseased › Hamman's (spontaneous mediastinal emphysema)
- Emphysema › interstitial
- Emphysema › mediastinal
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