Excludes1 pair
R55 vs R57.9
R55 and R57.9 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 R55
shock NOS (R57.9)
R55
Syncope and collapse
Billable
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R50-R69
Use when the record says
- Blackout
- Fainting
- Vasovagal attack
Indexed under
- Blackout
- Collapse
- Fainting (fit)
- Near-syncope
- Pre-syncope
R57.9
Shock, unspecified
BillableUnspecified
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R50-R69
Use when the record says
- Failure of peripheral circulation NOS
Indexed under
- Shock
- Circulation › failure (peripheral)
- Collapse › circulatory (peripheral)
- Collapse › vascular (peripheral)
- Failure, failed › circulation, circulatory (peripheral)
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