FY2027
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Excludes1 pair

K04.6 vs K05.2-

K04.6 and K05.2 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 K05.2
periapical abscess with sinus (K04.6)
K04.6

Periapical abscess with sinus

Billable
Chapter 11
Diseases of the digestive system
Section
K00-K14
Use when the record says
  • Dental abscess with sinus
  • Dentoalveolar abscess with sinus
Indexed under
  • Fistula › alveolar process
  • Fistula › dental
  • Fistula › from periapical abscess
  • Gumboil › with sinus
  • Parulis › with sinus
K05.2

Aggressive periodontitis

Not billable
Chapter 11
Diseases of the digestive system
Section
K00-K14
Use when the record says
  • Acute pericoronitis

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