2027 ICD-10-CM Diagnosis Code T49.5X5AAdverse effect of ophthalmological drugs and preparations, initial encounter

ICD-10-CM Codes›S00–T88›T36-T50›T49

ICD-10-CM T49.5X5A
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

T49.5X5A is a billable ICD-10-CM diagnosis code for adverse effect of ophthalmological drugs and preparations, initial encounter. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 791, 793, 917 through 918. The code is not accepted as a principal diagnosis by the Medicare Code Editor. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Adverse effects of drugs and medicaments, initial encounter.

Code Identity

ICD-10-CM Code
T49.5X5A
Billable Status
Yes — Valid for Submission
Code Describes
Adverse effect of ophthalmological drugs and preparations, initial encounter
Short Description
Adverse effect of opth drugs and preparations, init
Parent Code
Adverse effect of ophthalmological drugs and preparations

Code Classification

ChapterS00–T88Injury, poisoning and certain other consequences of external causes
SectionT36-T50Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
CategoryT49Poisoning by, adverse effect of and underdosing of topical agents primarily affecting skin and mucous membrane and by ophthalmological, otorhinorlaryngological and dental drugs
This CodeT49.5X5AAdverse effect of ophthalmological drugs and preparations, initial encounter

Code EditsBilling

Medicare Code Editor checks that affect claim validity for T49.5X5A.

There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Anticholinesterase parasympathomimetic adverse reaction
  • Cellulose-derived viscosity modifier adverse reaction
  • Corticosteroid-induced open angle glaucoma
  • Demecarium adverse reaction
  • Dipivefrine adverse reaction
  • Drug-induced ocular hypertension
  • Drug-induced ocular hypertension of left eye
  • Drug-induced ocular hypertension of right eye
  • Drug-induced open angle glaucoma
  • Drug-induced open angle glaucoma of bilateral eyes
  • Drug-induced open angle glaucoma of left eye
  • Drug-induced open angle glaucoma of right eye
  • Drug-induced uveitis
  • Ecothiopate adverse reaction
  • Hypromellose adverse reaction
  • Hypromellose eye drops adverse reaction
  • Lachesine chloride adverse reaction
  • Levobunolol adverse reaction
  • Metipranolol adverse reaction
  • Metipranolol-induced anterior uveitis
  • Ocular hypertension of left eye caused by corticosteroid
  • Ocular hypertension of right eye caused by corticosteroid
  • Open angle glaucoma of bilateral eyes caused by corticosteroid
  • Open angle glaucoma of left eye caused by corticosteroid
  • Open angle glaucoma of right eye caused by corticosteroid
  • Ophthalmological drug side effect
  • Ophthalmological monitoring status
  • Physostigmine adverse reaction
  • Prednisolone adverse reaction
  • Prednisolone drops adverse reaction
  • Secondary ocular hypertension caused by corticosteroid
  • Uveitis caused by ranibizumab
  • Viscosity modifier adverse reaction

Coding GuidelinesGuidance

When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug.

The appropriate 7th character is to be added to each code from block Poisoning by, adverse effect of and underdosing of topical agents primarily affecting skin and mucous membrane and by ophthalmological, otorhinorlaryngological and dental drugs (T49). Use the following options for the applicable episode of care:

  • A - initial encounter
  • D - subsequent encounter
  • S - sequela

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, published by CMS and the National Center for Health Statistics.

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to T49.5X5A: its own notes plus those printed at T49, block T36-T50, and Chapter 19. A note printed at a category, block or chapter applies to every code under it.

Includes

Further defines, or gives examples of, the content of the category.

From T49 Poisoning by, adverse effect of and underdosing of topical agents primarily affecting skin and mucous membrane and by ophthalmological, otorhinorlaryngological and dental drugs applies to 180 codes
  • poisoning by, adverse effect of and underdosing of glucocorticoids, topically used
From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • adverse effect of correct substance properly administered
  • poisoning by overdose of substance
  • poisoning by wrong substance given or taken in error
  • underdosing by (inadvertently) (deliberately) taking less substance than prescribed or instructed

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • toxic reaction to local anesthesia in pregnancy (O29.3-)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • abuse and dependence of psychoactive substances (F10-F19)
  • abuse of non-dependence-producing substances (F55.-)
  • immunodeficiency due to drugs (D84.821)
  • drug reaction and poisoning affecting newborn (P00-P96)
  • pathological drug intoxication (inebriation) (F10-F19)
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes

Code First

The underlying condition named in the note is sequenced before this code.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • for adverse effects, the nature of the adverse effect, such as:
  • adverse effect NOS (T88.7)
  • aspirin gastritis (K29.-)
  • blood disorders (D56-D76)
  • contact dermatitis (L23-L25)
  • dermatitis due to substances taken internally (L27.-)
  • nephropathy (N14.0-N14.2)

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • code(s) to specify:
  • manifestations of poisoning
  • underdosing or failure in dosage during medical and surgical care (Y63.6, Y63.8-Y63.9)
  • underdosing of medication regimen (Z91.12-, Z91.13-)
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • code to identify any retained foreign body, if applicable (Z18.-)

Notes

General instructions on how these codes are used.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • The drug giving rise to the adverse effect should be identified by use of codes from categories T36-T50 with fifth or sixth character 5.
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
  • The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.

7th Character

Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.

From T49 Poisoning by, adverse effect of and underdosing of topical agents primarily affecting skin and mucous membrane and by ophthalmological, otorhinorlaryngological and dental drugs applies to 180 codes
  • The appropriate 7th character is to be added to each code from category T49
  • Ainitial encounter this code
  • Dsubsequent encounter
  • Ssequela

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name T49.5X5A, its category, or a range that includes it.

Excludes1 3

These codes carry an Excludes1 note naming T49.5X5A: they are not reported together with it, unless the two conditions are unrelated.

  • T36 Poisoning by, adverse effect of and underdosing of systemic antibiotics
    topically used antibiotic for eye (T49.5) names T49.5, which includes this code
  • T37 Poisoning by, adverse effect of and underdosing of other systemic anti-infectives and antiparasitics
    anti-infectives topically used for eye (T49.5-) names T49.5-, which includes this code
  • T38.0 Poisoning by, adverse effect of and underdosing of glucocorticoids and synthetic analogues
    glucocorticoids, topically used (T49.-) names T49.-, which includes this code

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR INJ028
Adverse effects of drugs and medicaments, initial encounter
Default principal diagnosis: inpatient No · outpatient Yes

Table of Drugs and ChemicalsClinical

Substances in the Table of Drugs and Chemicals that reference this code family. Always confirm in the Tabular List before coding.

SubstanceAccidentalSelf-harmAssaultUndeter­minedAdverse
Effect
Under­dosing
Achromycin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Adrenal (extract, cortex or medulla) (glucocorticoids) (hormones) (mineralocorticoids)::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Aerosporin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Ammonium::acid tartrateT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Antibiotic NEC::eyeT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Anticholinesterase::reversible::ophthalmologicalT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Anti-infective NEC::eye NECT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Anti-infective NEC::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Antiviral drug NEC::eyeT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Argyrol::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Aristocort::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Aureomycin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Bacimycin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Bacitracin zinc::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
BefunololT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Benzalkonium (chloride)::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
BibrocatholT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Boracic acid::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Boric acid::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Chloramphenicol::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Chloromycetin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
ChloropticT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Chymar::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Chymotrypsin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Colistin::sulfate (eye preparation)T49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Contact lens solutionT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Copper (dust) (fumes) (nonmedicinal) NEC::sulfate::cupric::medicinal::eyeT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Copper (dust) (fumes) (nonmedicinal) NEC::sulfate::medicinal::eyeT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Cort-Dome::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Cortef::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Corticosteroid::ophthalmicT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Cortisol::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Cortisone (acetate)::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Cortogen::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Cortone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Cortril::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Cycloplegic drugT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Decadron::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Demecarium (bromide)T49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
DendridT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Dexamethasone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
DipivefrineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Echothiophate, echothiopate, ecothiopateT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Ecothiopate iodideT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
EdoxudineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Erythromycin (salts)::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
EserineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
EucatropineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
External medications (skin) (mucous membrane)::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Eye agents (anti-infective)T49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Eye drug NECT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Florinef::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Fludrocortisone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Fluohydrocortisone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Fluorometholone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
FluorphenylalanineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Garamycin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Gentamicin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
HerplexT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Hydrocortisone (derivatives)::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Hydrocortone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
HydroxyamphetamineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
HypromelloseT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Ilotycin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Irrigating fluid (vaginal)::eyeT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
LachesineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
LevobunololT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Lubricant, eyeT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Merthiolate::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Methyl::prednisolone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Methylparaben (ophthalmic)T49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
MetipranololT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Miotic drugT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Mycitracin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Mydriatic drugT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Neomycin (derivatives)::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Neosporin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Orthoboric acid::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Oxylone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
PhospholineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
PhysostigmineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Polymyxin::B::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Polymyxin::E sulfate (eye preparation)T49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Prednisolone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Propylparaben (ophthalmic)T49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Silver::nitrate::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Silver::proteinT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Sodium::borate::cleanser::eyeT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Steroid::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
StoxilT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Sulfacetamide::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Sulfisoxazole::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Sulfonamide NEC::eyeT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Tear::solutionT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Tetracycline::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
TetrahydrozolineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
TetryzolineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Thimerosal::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Topical action drug NEC::eyeT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Triamcinolone::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Tyrothricin::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
VisineT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Zephiran (topical)::ophthalmic preparationT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Zinc (compounds) (fumes) (vapor) NEC::sulfateT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6
Zinc (compounds) (fumes) (vapor) NEC::sulfate::ophthalmic solutionT49.5X1T49.5X2T49.5X3T49.5X4T49.5X5T49.5X6

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Convert T49.5X5A to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
995.29 Adv eff med/biol NEC/NOS
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.
ICD-9-CM
E946.5 Adv eff eye anti-inf/drg
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About T49.5X5AOverview

Is T49.5X5A (Adverse effect of ophthalmological drugs and preparations) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report adverse effect of ophthalmological drugs and preparations, initial encounter on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What does the 7th character A in T49.5X5A mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for adverse effect of ophthalmological drugs and preparations, such as an emergency visit or first evaluation.

What MS-DRG does T49.5X5A group to?

On inpatient claims, adverse effect of ophthalmological drugs and preparations, initial encounter maps to MS-DRG 793, 791, 918, 917, with relative weights from 0.8716 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.

Can T49.5X5A be a principal diagnosis?

No. The Medicare Code Editor rejects this code as a principal diagnosis because adverse effect of ophthalmological drugs and preparations, initial encounter describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.

Can T49.5X5A be reported with a code from O29.3?

Not as a rule. The Excludes1 note at block T36-T50, which applies to T49.5X5A, lists "toxic reaction to local anesthesia in pregnancy (O29.3-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).