N11.0 vs N13.7
N11.0 and N13.7 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on N13.7
reflux-associated pyelonephritis (N11.0)
N11.0
Nonobstructive reflux-associated chronic pyelonephritis
Billable
- Chapter 14
- Diseases of the genitourinary system
- Section
- N10-N16
Use when the record says
- Pyelonephritis (chronic) associated with (vesicoureteral) reflux
Indexed under
- Pyelonephritis › nonobstructive › with reflux
- Pyelonephritis › chronic › nonobstructive › with reflux
- Reflux › vesicoureteral › with › pyelonephritis
- Nephritis, nephritic › tubulo-interstitial › chronic › nonobstructive › reflux-associated (albuminuric) (azotemic) (congenital) (disseminated) (epithelial) (familial) (focal) (granulomatous) (hemorrhagic) (infantile) (nonsuppurative, excretory) (uremic)
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