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I46.9 vs R57.0

I46.9 (Cardiac arrest, cause unspecified) compared with R57.0 (Cardiogenic shock), from the official CMS tabular data.

Summary

These codes can be reported together when both conditions are documented, because I46.9 lists R57.0 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

The conditions named and chapter.I46.9 is “Cardiac arrest, cause unspecified”; R57.0 is “Cardiogenic shock”. I46.9 sits in I00-I99 — Diseases of the Circulatory System (I00-I99); R57.0 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.I46.9 lists R57.0 under Excludes2: “cardiogenic shock (R57.0)”. 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. R57.0 carries 13 Excludes1 notes covering other codes; the side-by-side table quotes them.

Official rule

Is there an Excludes2 relationship?

Yes.I46.9’s tabular entry: “cardiogenic shock (R57.0)”. The note covers R57.0.

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

I46.9
Cardiac arrest, cause unspecified
↔
R57.0
Cardiogenic shock

What we found

Yes, when both are documented.I46.9 carries an Excludes2 note covering R57.0: “cardiogenic shock (R57.0)”

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 FY2027

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

I46.9Cardiac arrest, cause unspecifiedR57.0Cardiogenic shock
Billing statusBillableBillable
ClassificationI00-I99 — Diseases of the Circulatory System (I00-I99)R00-R99 — Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)
DefinitionCardiac arrest, cause unspecified is a billable ICD-10-CM diagnosis code (I46.9).Cardiogenic shock is a billable ICD-10-CM diagnosis code (R57.0).
Excludes1—
anaphylactic shock NOS (T78.2)
anaphylactic reaction or shock due to adverse food reaction (T78.0-)
anaphylactic shock due to adverse effect of correct drug or medicament properly administered (T88.6)
anaphylactic shock due to serum (T80.5-)
electric shock (T75.4)
obstetric shock (O75.1)
postprocedural shock (T81.1-)
psychic shock (F43.0)
shock complicating or following ectopic or molar pregnancy (O00-O07, O08.3)
shock due to anesthesia (T88.2)
shock due to lightning (T75.01)
traumatic shock (T79.4)
toxic shock syndrome (A48.3)
Excludes2
cardiogenic shock (R57.0)
septic shock (R65.21)

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