Excludes1 pair
K04.5 vs K05.3-
K04.5 and K05.3 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 K05.3
chronic apical periodontitis (K04.5)
K04.5
Chronic apical periodontitis
Billable
- Chapter 11
- Diseases of the digestive system
- Section
- K00-K14
Use when the record says
- Apical or periapical granuloma
- Apical periodontitis NOS
Indexed under
- Granuloma › apical
- Granuloma › dental
- Granuloma › periapical
- Infection, infected, infective › periapical
- Periodontitis › apical
K05.3
Chronic periodontitis
Not billable
- Chapter 11
- Diseases of the digestive system
- Section
- K00-K14
Use when the record says
- Chronic pericoronitis
- Complex periodontitis
- Periodontitis NOS
- Simplex periodontitis
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