Excludes1 pair

N28.1 vs Q61-

N28.1 and Q61 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 N28.1
cystic kidney disease (congenital) (Q61.-)
N28.1

Cyst of kidney, acquired

Billable
Chapter 14
Diseases of the genitourinary system
Section
N25-N29
Use when the record says
  • Cyst (multiple) (solitary) of kidney (acquired)
Indexed under
  • Cyst › kidney
  • Cyst › paranephric
  • Cyst › peripelvic (lymphatic)
  • Solitary › cyst, kidney
  • Cyst › kidney › acquired
Q61

Cystic kidney disease

Not billable
Chapter 17
Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders
Section
Q60-Q64

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