FY2027
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Excludes1 pair

N04.5 vs N04.A

N04.5 and N04.A 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 N04.5
Nephrotic syndrome with C3 glomerulonephritis (N04.A)
N04.5

Nephrotic syndrome with diffuse mesangiocapillary glomerulonephritis

Billable
Chapter 14
Diseases of the genitourinary system
Section
N00-N08
Indexed under
  • Nephrosis, nephrotic › with › hypocomplementemic
  • Syndrome › nephrotic › with › diffuse › mesangiocapillary glomerulonephritis
N04.A

Nephrotic syndrome with C3 glomerulonephritis

Billable
Chapter 14
Diseases of the genitourinary system
Section
N00-N08
Use when the record says
  • Nephrotic syndrome with C3 glomerulopathy
Indexed under
  • Syndrome › nephrotic › with › C3 › glomerulonephritis
  • Syndrome › nephrotic › with › C3 › glomerulopathy

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