Z60.4 vs Z60.5
Z60.4 and Z60.5 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 Z60.4
target of adverse discrimination such as for racial or religious reasons (Z60.5)
Z60.4
Social exclusion and rejection
Billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z55-Z65
Use when the record says
- Exclusion and rejection on the basis of personal characteristics, such as unusual physical appearance, illness or behavior.
- Social isolation
Indexed under
- Deprivation › social
- Isolation, isolated › social
- Social › exclusion
- Social › rejection
- Problem › social › exclusion and rejection (with) (related to)
Z60.5
Target of (perceived) adverse discrimination and persecution
Billable
- Chapter 21
- Factors influencing health status and contact with health services
- Section
- Z55-Z65
Indexed under
- Discrimination › ethnic
- Discrimination › political
- Discrimination › racial
- Discrimination › religious
- Discrimination › sex
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