O92.3 vs O92.5
O92.3 and O92.5 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 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
- Lactation, lactating › failed (breast) (puerperal, postpartum)
- Puerperal, puerperium › failure › lactation (complicated by, complications)
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 (primary)
- 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