FY2027
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Excludes1 pair

K64- vs O22.4-

K64 and O22.4 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 K64
hemorrhoids complicating pregnancy (O22.4)
K64

Hemorrhoids and perianal venous thrombosis

Not billable
Chapter 11
Diseases of the digestive system
Section
K55-K64
Use when the record says
  • piles
O22.4

Hemorrhoids in pregnancy

Not billable
Chapter 15
Pregnancy, childbirth and the puerperium
Section
O20-O29
Indexed under
  • Hemorrhoids › complicating › pregnancy
  • Pregnancy › complicated by › hemorrhoids
  • Varix › complicating › pregnancy › anus or rectum

These two codes sit in different chapters of the Tabular List, which is usually the clearest signal that they describe different underlying processes rather than different degrees of the same one.

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