FY2027
MenuClose
Excludes1 pair

Z60.4 vs Z60.5

Z60.4 and Z60.5 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 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
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