Excludes1 pair
O92.3 vs O92.5
O92.3 and O92.5 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 O92.3
Elective agalactia (O92.5)
O92.3
Agalactia
Billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O85-O92
Use when the record says
- Primary agalactia
Indexed under
- Agalactia (primary)
- Failure, failed › lactation (complete)
- Lactation, lactating › failed (complete)
- Puerperal, puerperium › failure › lactation (complete)
O92.5
Suppressed lactation
Billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O85-O92
Use when the record says
- Elective agalactia
- Secondary agalactia
- Therapeutic agalactia
Indexed under
- Agalactia › elective, secondary or therapeutic
- Suppression › lactation
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