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D65 vs R78.72

D65 (Disseminated intravascular coagulation [defibrination syndrome]) compared with R78.72 (Abnormal gadolinium level in blood), from the official CMS tabular data.

Summary

These codes can be reported together when both conditions are documented, because R78.72 lists D65 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

The conditions named and chapter.D65 is “Disseminated intravascular coagulation [defibrination syndrome]”; R78.72 is “Abnormal gadolinium level in blood”. D65 sits in D50-D89 — Diseases of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89); R78.72 in R00-R99 — Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99).

Registry fact

Can these codes be reported together?

Yes, when both are documented.R78.72 lists D65 under Excludes2: “coagulation hemorrhagic disorders (D65-D68)”. Excludes2 marks distinct conditions that may both be reported when both are documented.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

None.Neither entry carries an Excludes1 note that names the other code. D65 carries 3 Excludes1 notes and R78.72 carries 1 Excludes1 note covering other codes; the side-by-side table quotes them.

Official rule

Is there an Excludes2 relationship?

Yes.R78.72’s tabular entry: “coagulation hemorrhagic disorders (D65-D68)”. The note covers D65.

Official ruleGuide: Excludes1 vs Excludes2

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

No.Both are billable codes, and neither contains the other.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Informational

Excludes2 relationship

R78.72
Abnormal gadolinium level in blood
↔
D65
Disseminated intravascular coagulation [defibrination syndrome]

What we found

Yes, when both are documented.R78.72 carries an Excludes2 note covering D65: “coagulation hemorrhagic disorders (D65-D68)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.b — Excludes2 · applies to: Excludes2

    A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

    ICD-10-CM Official Guidelines FY2026

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

D65Disseminated intravascular coagulation [defibrination syndrome]R78.72Abnormal gadolinium level in blood
Billing statusBillableBillable
ClassificationD50-D89 — Diseases of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89)R00-R99 — Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)
DefinitionDisseminated intravascular coagulation [defibrination syndrome] is a billable ICD-10-CM diagnosis code (D65).Abnormal gadolinium level in blood is a billable ICD-10-CM diagnosis code (R78.72).
Includes
Afibrinogenemia, acquired
Consumption coagulopathy
COVID-19 associated diffuse or disseminated intravascular coagulopathy
Diffuse or disseminated intravascular coagulation [DIC]
—
Excludes1
disseminated intravascular coagulation (complicating):
in newborn (P60)
pregnancy, childbirth and the puerperium (O45.0, O46.0, O67.0, O72.3)
toxic effect of gadolinium (T56.82-)
Excludes2
disseminated intravascular coagulation (complicating):
abortion or ectopic or molar pregnancy (O00-O07, O08.1)
mental or behavioral disorders due to psychoactive substance use (F10-F19)
abnormal findings on antenatal screening of mother (O28.-)
abnormalities of lipids (E78.-)
abnormalities of platelets and thrombocytes (D69.-)
abnormalities of white blood cells classified elsewhere (D70-D72)
coagulation hemorrhagic disorders (D65-D68)
diagnostic abnormal findings classified elsewhere - see Alphabetical Index
hemorrhagic and hematological disorders of newborn (P50-P61)
Use additional code—
code to identify any retained foreign body, if applicable (Z18.-)
Code also
, if applicable, associated condition
—

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources