FY2027
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Excludes1 pair

M31.5 vs M35.3

M31.5 and M35.3 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 M35.3
polymyalgia rheumatica with giant cell arteritis (M31.5)
M31.5

Giant cell arteritis with polymyalgia rheumatica

Billable
Chapter 13
Diseases of the musculoskeletal system and connective tissue
Section
M30-M36
Indexed under
  • Polymyalgia › arteritica, giant cell
  • Arteritis › giant cell NEC › with polymyalgia rheumatica
  • Polymyalgia › rheumatica › with giant cell arteritis
M35.3

Polymyalgia rheumatica

Billable
Chapter 13
Diseases of the musculoskeletal system and connective tissue
Section
M30-M36
Indexed under
  • Forestier's disease (rhizomelic pseudopolyarthritis)
  • Polymyalgia
  • Pseudopolyarthritis, rhizomelic
  • Disease, diseased › Forestier's (rhizomelic pseudopolyarthritis)
  • Polymyalgia › rheumatica

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